Non-collision Athletes Research Articles

An Examination of Visual Quality of Life and Functional Vision Among Collision and Non-Collision Athletes Over a Competitive Season.

Repetitive head impacts (RHIs) experienced during sports are gaining attention due to potential long-term neurological dysfunction, absent of a diagnosed concussion. One area susceptible to dysfunction is vision. The goal of this study was to evaluate changes in visual quality of life (VQOL) and functional vision scores from pre- to post-season among collision and non-collision athletes. The Visual Functioning Questionnaire-25 and Neuro-Ophthalmic Supplement (NOS), as well as functional vision testing (Mobile Universal Lexicon Evaluation System - MULES) were completed pre- and post-season by three groups: collision athletes, non-collision athletes, and minimally active controls (MACs). There were 42 participants, with 41 (21 male, 20 female) completing both testing sessions, with a mean (standard deviation [SD]) age of 21 (2.46) years (collision group, n = 14; non-collision group, n = 13, MACs, n = 14). Baseline analyses revealed no significant differences between groups for VQOL or MULES scores. However, those with a family history of psychiatric disorder scored significantly worse on NOS. Post-season/follow-up testing revealed no significant differences between groups for VQOL scores. Non-collision athletes significantly improved on the MULES test by 2.46 ± 3.60 (SD) s (35.0 [95% confidence interval, 0.29-4.63]; p = .03). Change score results from pre- to post-season were not significant. Although the groups were not significantly different from one another, non-collision athletes significantly improved MULES scores, whereas collision athletes performed the worst, suggesting exposure to RHIs may impact functional vision. Thus, further evaluation of RHIs and their impact on vision is warranted.

Distance to Dislocation and Recurrent Shoulder Dislocation After Arthroscopic Bankart Repair: Rethinking the Glenoid Track Concept

Background: The “distance to dislocation” (DTD) calculation has been proposed as 1 method to predict the risk of recurrent dislocation after arthroscopic Bankart repair for an “on-track” shoulder. Rates of recurrent dislocation at specific DTD values are unknown. Hypothesis: Among patients with “on-track” shoulder lesions who underwent primary arthroscopic Bankart repair, the rate of recurrent dislocation would increase as DTD values decrease. Study Design: Case-control study; Level of evidence, 3. Methods: We performed a retrospective analysis of 188 patients with “on-track” shoulder lesions who underwent primary arthroscopic anterior labral repair between 2007 and 2019, with a minimum 2-year follow-up. Glenoid bone loss, Hill-Sachs interval, glenoid track, and DTD were determined from preoperative magnetic resonance imaging scans. The rate of recurrent dislocation was determined at 2-mm DTD intervals. Univariate and multivariate regression analyses were used to evaluate the relationship between recurrent dislocation, patient characteristics, and bone loss variables. A multivariate regression model was created to predict the probability of failure at continuous DTD values. A subgroup analysis of failure rate based on collision sports participation was also performed. Results: A total of 29 patients (15.4%) sustained recurrent dislocations. Patient age (P = .046), multiple dislocations (P = .03), glenoid bone loss (P < .001), Hill-Sachs interval length (P < .001), and DTD (P < .001) were all independent predictors of failure. As the DTD decreased, the rate of recurrent dislocation increased. Below a DTD threshold of 10 mm, the recurrent dislocation rate increased exponentially. Up to a threshold of 24 mm, the failure rate for collision athletes remained >12.3%, independent of the DTD. Conversely, the failure rate among noncollision athletes decreased steadily as the DTD increased. Conclusion: For “on-track” shoulder lesions, as the DTD approached 0 mm (“off-track” threshold), the risk of recurrent dislocation after arthroscopic Bankart repair increased significantly. Below a DTD threshold of 10 mm, the risk of failure increased exponentially. The risk of recurrent dislocation for collision sports athletes remained elevated at higher DTD values than for noncollision athletes.

White and Gray Matter Abnormalities in Australian Footballers With a History of Sports-Related Concussion: An MRI Study.

Sports-related concussion (SRC) is a form of mild traumatic brain injury that has been linked to long-term neurological abnormalities. Australian rules football is a collision sport with wide national participation and is growing in popularity worldwide. However, the chronic neurological consequences of SRC in Australian footballers remain poorly understood. This study investigated the presence of brain abnormalities in Australian footballers with a history of sports-related concussion (HoC) using multimodal MRI. Male Australian footballers with HoC (n = 26), as well as noncollision sport athletes with no HoC (n = 27), were recruited to the study. None of the footballers had sustained a concussion in the preceding 6 months, and all players were asymptomatic. Data were acquired using a 3T MRI scanner. White matter integrity was assessed using diffusion tensor imaging. Cortical thickness, subcortical volumes, and cavum septum pellucidum (CSP) were analyzed using structural MRI. Australian footballers had evidence of widespread microstructural white matter damage and cortical thinning. No significant differences were found regarding subcortical volumes or CSP. These novel findings provide evidence of persisting white and gray matter abnormalities in Australian footballers with HoC, and raise concerns related to the long-term neurological health of these athletes.

Return to sports after the latarjet procedure: high return level of non-collision athletes.

The purpose of this study was to compare the clinical outcomes, including the level of return to sport, of collision and non-collision athletes who had the Latarjet procedure. A total of 56 shoulders of 29 collision and 27 non-collision athletes were retrospectively analyzed. All study participants underwent the Latarjet procedure between 2007 and 2014. Median age at the time of surgery was 26.5years(18-43) and follow-up duration was 67.0months(24-113). At the final follow-up, 54 (96.4%) patients returned to sports. Nine patients (16.1%) returned to the same level of sports. In a group of collision athletes, 1 patient (3.4%) returned to the same level, 16 (55.2%) returned to lower level, 10 (34.5%) changed sports, and 2 (6.9%) quit sports. In a group of noncollision athletes, 8 (29.6%) returned to same level, 11 (40.7%) returned at a lower level and 8 (29.6%) changed sports. The level of return to sports in collision group was statistically different from that in noncollision group (p = 0.046). The mean VAS, Rowe and UCLA scores improved significantly in both groups (p < 0.001) with no statistically significant difference between both groups. Although the clinical outcomes were not significantly different between collision and non-collision athletes, the level of return to sports was significantly higher in the non-collision group than in the collision group. The result suggests that the level of physical demand according to sport type is an important prognostic factor which predicts the level of return to sport after the Lartarjet procedure in athletes. IV.

Are collision athletes at a higher risk of re-dislocation after an open Bristow-Latarjet procedure? A systematic review and meta-analysis.

The primary aim of the present study was to review, summarize and compare the redislocation risk for collision athletes and noncollision athletes after an open Bristow-Latarjet procedure. Our secondary aim was to summarize return to sport, satisfaction, pain and complications. We conducted a systematic review in PubMed and EMBASE of articles until 1 July 2016. We included all studies describing Bristow-Latarjet like procedures as a result of glenohumeral instability, mentioning redislocation rates in collision athletes with >2 years of follow-up. We pooled the data using random-effects meta-analysis for redislocation risk-differences (RD) between collision and noncollision athletes, and assessed heterogeneity with I2 and Tau2 tests. From 475 titles and abstracts, 11 studies were included and eight studies were meta-analyzed. The pooled RD to develop a postoperative redislocation between collision athletes and noncollision athletes was -0.00 (95% confidence interval: -0.03 to 0.03, p = 0.370). Return to sports rates were high (67-100%), and patients reported high satisfaction scores (93-100% satisfied) and low pain scores (mean visual analogue scale score of 1.6); however, postoperative complication rates varied from 0.8% to 19.2%. Collision athletes are not more at risk for redislocation rates after an open Bristow-Latarjet procedure compared to noncollision athletes. Overall postoperative outcomes were good, although numerous complications occurred.

Conjoined Tendon Transfer for Traumatic Anterior Glenohumeral Instability in Patients With Large Bony Defects and Anterior Capsulolabral Deficiency

To report outcomes of a conjoined tendon transfer procedure in a small case series of young active patients of various activity levels with recurrent traumatic anterior shoulder instability. A retrospective chart review identified 10 consecutive patients who underwent conjoined tendon transfer (8 open and 2 arthroscopic) for anterior glenohumeral instability from January 2009 through December 2012. The indications were traumatic anterior shoulder instability with 25% or greater anterior glenoid bone loss, engaging Hill-Sachs lesion, or absent anterior-inferior labral tissue with anterior capsular tissue that did not readily hold sutures or a combination of these deficiencies. Patients did not undergo the procedure if they had healthy capsulolabral tissue and small bony defects or if they competed in high-level collision sports or were overhead throwers. The American Shoulder and Elbow Surgeons (ASES) questionnaire and a physical examination were completed preoperatively. Postoperatively, patients answered questions about shoulder stability and completed ASES and Western Ontario Shoulder Index questionnaires. A physical examination was performed postoperatively to assess range of motion. Of 10 patients, 9 were available for follow-up. The mean age was 33.0years (range, 18-51years) at the time of surgery. Eight of nine patients underwent a physical examination at 31.3±10.5months (range, 24-58months) postoperatively. There were no revisions or complications except for recurrent instability in 1 patient who underwent the arthroscopic procedure and reported gross deviation from the postoperative protocol. The ASES score improved significantly (62.8 ± 21.2 at baseline vs 89.2 ± 11.5 at final follow-up, P= .01). The postoperative Western Ontario Shoulder Index score was 74.5 ± 19.7. No significant change was found in external rotation in 90° of abduction (80.6° ± 12.9° at baseline vs 88.4° ± 6.1° at final follow-up, P= .11) or in flexion (145.6°±14.9° at baseline vs 153.1° ± 16.4° at final follow-up, P= .19). All patients returned to their previous activity level. Stability was restored and no significant range-of-motion loss was observed in noncollision athletes who underwent conjoined tendon transfer. Recurrent instability occurred in 1 patient who underwent the arthroscopic procedure. There were no other complications. Level IV, therapeutic case series.

Cerebrovascular Reactivity Alterations in Asymptomatic High School Football Players

Cerebrovascular reactivity (CVR) is impaired following brain injury, increasing susceptibility to subsequent injury. CVR was tracked in football and non-collision athletes throughout one season. CVR transiently decreased in football athletes during the first half of the season. Results indicate the brain adapts slowly to increases in loading, increasing risk for injury.

Outcomes of Arthroscopic Bankart Repair in Collision Versus Noncollision Athletes

The purpose of the study was to compare the recurrence rate of arthroscopic Bankart repair with suture anchors in collision vs noncollision athletes. Sixty-four patients who underwent arthroscopic shoulder stabilization using suture anchors for recurrent anterior dislocation were identified. Forty-three patients (22 collision and 21 noncollision) were evaluated at a minimum 24-month follow-up. The recurrence rate was reported, and functional outcomes (American Shoulder and Elbow Society, Western Ontario Shoulder Index, and Short Form 12) were evaluated. Statistical analysis was performed using chi-square test and Student's t test with a 95% confidence interval and a significance level set at a P value less than .05. The overall dislocation recurrence rate was 4.6% (2 of 43 patients); the dislocation recurrence rate in collision athletes was 9% (2 of 22 patients), and no redislocations occurred in noncollision athletes. No statistical differences existed in Western Ontario Shoulder Index score (73.5% in collision and 73.4% in noncollision athletes; P=.831), American Shoulder and Elbow Society score (91.2 in collision and 80.7 in noncollision athletes; P=.228), and Short Form 12 score (108.5 in collision and 101.2 in noncollision athletes; P=.083). Average external rotation loss was 6.8° in collision and 5.5° in noncollision athletes (P=.864). Ninety percent of collision athletes vs 95% of noncollision athletes were satisfied. Seventy-three percent of collision and 81% of noncollision athletes were able to return to sport at their preinjury levels. Collision athletes had higher recurrence rates after arthroscopic shoulder stabilization compared with noncollision athletes, but no statistical difference was found. Functional outcomes according to American Shoulder and Elbow Society, Western Ontario Shoulder Index, and Short Form 12 were similar.

Arthroscopic Bankart Repair With Suture Anchors in Collision Versus Non-collision Athletes (SS-10)

Introduction Open Bankart repair has been considered the gold standard for the treatment of anterior shoulder instability in collision athletes. However, recent improvements in arthroscopic techniques and the use of suture anchors have led to comparable recurrence rates. The purpose of this study was to evaluate the outcomes of arthroscopic shoulder stabilization with suture anchors in collision versus non-collision athletes. Methods A search in the senior author's database was performed; 125 labral repairs were identified between December 2005 and April 2008. 64 patients respected the inclusion criteria, 40 (20 collision athletes and 20 non-collision) were available to be evaluated at minimum 24 months' follow-up. All patients underwent arthroscopic Bankart repair with suture anchors. Recurrence rate was reported and functional outcomes according to ASES score, WOSI and SF-12 were evaluated. Statistical analysis was performed using chi-square and Student t test with 95% confidence interval (CI) and significance level set at p < 0.05. Results Overall recurrence rate (dislocation) was 5% (2 cases out of 40 patients); recurrence rate in collision athletes was 10% (2 cases out of 20 patients), no re-dislocations occurred in non-collision athletes. Two non-collision athletes presented with mild apprehension; 1 collision athlete and 1 non-collision complained of an episode of subjective instability, with a negative apprehension. WOSI score in collision group was 75.3% versus 72.6% in non-collision; ASES score was 90.6 in collision versus 81.2 in non-collision; SF-12 score was 108.2 in collision versus 101.1 in non-collision. Average loss in external rotation was 6.05° in non-collision versus 5.52° in collision; 95% of non-collision athletes were satisfied versus 90% of collision; 70% of non-collision athletes were able to return to sport at the same level versus 60% of collision. Nine of 9 professional athletes returned to the same activity level. Conclusion Collision athletes presented higher recurrence rate compared to non-collision athletes but there was no statistical difference. The functional outcomes according to ASES, WOSI and SF-12 were similar. Open Bankart repair has been considered the gold standard for the treatment of anterior shoulder instability in collision athletes. However, recent improvements in arthroscopic techniques and the use of suture anchors have led to comparable recurrence rates. The purpose of this study was to evaluate the outcomes of arthroscopic shoulder stabilization with suture anchors in collision versus non-collision athletes. A search in the senior author's database was performed; 125 labral repairs were identified between December 2005 and April 2008. 64 patients respected the inclusion criteria, 40 (20 collision athletes and 20 non-collision) were available to be evaluated at minimum 24 months' follow-up. All patients underwent arthroscopic Bankart repair with suture anchors. Recurrence rate was reported and functional outcomes according to ASES score, WOSI and SF-12 were evaluated. Statistical analysis was performed using chi-square and Student t test with 95% confidence interval (CI) and significance level set at p < 0.05. Overall recurrence rate (dislocation) was 5% (2 cases out of 40 patients); recurrence rate in collision athletes was 10% (2 cases out of 20 patients), no re-dislocations occurred in non-collision athletes. Two non-collision athletes presented with mild apprehension; 1 collision athlete and 1 non-collision complained of an episode of subjective instability, with a negative apprehension. WOSI score in collision group was 75.3% versus 72.6% in non-collision; ASES score was 90.6 in collision versus 81.2 in non-collision; SF-12 score was 108.2 in collision versus 101.1 in non-collision. Average loss in external rotation was 6.05° in non-collision versus 5.52° in collision; 95% of non-collision athletes were satisfied versus 90% of collision; 70% of non-collision athletes were able to return to sport at the same level versus 60% of collision. Nine of 9 professional athletes returned to the same activity level. Collision athletes presented higher recurrence rate compared to non-collision athletes but there was no statistical difference. The functional outcomes according to ASES, WOSI and SF-12 were similar.

Arthroscopic Stabilization in Anterior Shoulder Instability: Collision Athletes Versus Noncollision Athletes

Collision athletes have been reported to be at high risk of redislocation after stabilization for anterior shoulder instability. However, few studies have compared the results of arthroscopic stabilization with collision and noncollision athletes. The purposes of this study were to analyze clinical outcomes of arthroscopic anterior shoulder stabilization in athletes and to compare the results between collision and noncollision athletes. A total of 29 athletes were enrolled in this study, including 14 collision athletes and 15 noncollision athletes. Mean age at the time of operation was 21.1 years, and mean follow-up period was 62.1 months (range, 25 to 117 months). All shoulders underwent arthroscopic stabilization. Visual analogue scale score, Rowe score, and Constant score improved after surgery (P < .05), but no statistically significant difference was found between collision and noncollision groups (P < .05). In all, 19 athletes (65.5%) returned to near preinjury sports activity levels (90% or greater recovery) after operation. Five athletes (17.2%) experienced postoperative instability. One (3.4%) had subluxation and 4 (13.8%) had redislocation after surgery. Four cases in the collision group (28.6%) and 1 in the noncollision group (6.7%) had postoperative subluxation or dislocation (P = .118). Arthroscopic stabilization for anterior instability of the shoulder is a reliable procedure with respect to shoulder function, range of motion, and postoperative return to sports activities in athletes. However, a high recurrence rate (17.2%) was observed among athletes. Compared with the noncollision group (6.7%), the collision group yielded a higher failure rate (28.6%) than was expected. Level IV, prognostic case series.