Participation In Contact Sports Research Articles

Age of First Exposure to Contact Sports and Neurocognitive Performance in U.S. Service Academy Athletes

Abstract Purpose To examine the association between estimated age of first exposure (eAFE) to contact sports and neurocognitive performance and symptom ratings in collegiate U.S. Military Service Academy athletes. We hypothesized that contact-sports participation before the age of 12 would not be associated with worse neuropsychological test performance or greater symptom reporting. Methods Male cadets (N=891) who participated in contact sports [i.e., in lacrosse (n=211), wrestling (n=170), ice hockey (n=81), soccer (n=119), rugby (n=10)], or non-contact sports (n=298), completed the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test before the season. Generalized linear modeling was used to predict each cognitive domain score and the symptom severity score. Predictor variables were entered in the following order: group (contact vs. non-contact), eAFE (eAFE<12 vs. eAFE≥12), group-by-eAFE, and covariates for learning accommodation status, concussion history, and age. Results The group-by-eAFE interaction was not significant for any of the ImPACT composite scores (Verbal Memory, Wald Χ2=.073, p=.788; Visual Memory, Wald Χ2=2.71, p=.100; Visual Motor Speed, Wald Χ2=.078, p=.780; Reaction Time, Wald Χ2=.003, p=.955; Symptom Severity, Wald Χ2=2.87, p=.090). Learning accommodation history was associated with lower scores on Visual Motor Speed (Χ2=6.19, p=.013, B=-2.97). Older age was associated with faster reaction time (Χ2=4.40, p=.036, B=-.006) and lesser symptom severity (Χ2=5.55, p=.019, B=-.068). No other parameters were significant. Conclusion We observed no association between eAFE, contact-sport participation, cognitive functioning, or subjectively-experienced symptoms in this cohort. Earlier eAFE to RHI is not related to worse neurocognitive performance or greater subjectively-experienced symptoms in collegiate student-athletes enrolled in military academies.

Association between contact sports participation and chronic traumatic encephalopathy: a retrospective cohort study.

Chronic traumatic encephalopathy is a debilitating neurodegenerative disorder associated with repetitive traumatic brain injuries often sustained through prior contact sport participation. The frequency of this disorder in a diverse population, including amateur athletes, is unknown. Primary historical obituary and yearbook records were queried for 2566 autopsy cases in the Mayo Clinic Tissue Registry resulting in identification of 300 former athletes and 450 non‐athletes. In these cases, neocortical tissue was screened for tau pathology with immunohistochemistry, including pathology consistent with chronic traumatic encephalopathy, blinded to exposure or demographic information. Using research infrastructure of the Rochester Epidemiology Project, a comprehensive and established medical records‐linkage system of care providers in southern Minnesota and western Wisconsin, medical diagnostic billing codes pertaining to head trauma, dementia, movement disorders, substance abuse disorders and psychiatric disorders were recorded for cases and controls in a blinded manner. A total of 42 individuals had pathology consistent with, or features of, chronic traumatic encephalopathy. It was more frequent in athletes compared to non‐athletes (27 cases versus 15 cases) and was largely observed in men (except for one woman). For contact sports, American football had the highest frequency of chronic traumatic encephalopathy pathology (15% of cases) and an odds ratio of 2.62 (P‐value = 0.005). Cases with chronic traumatic encephalopathy pathology had higher frequencies of antemortem clinical features of dementia, psychosis, movement disorders and alcohol abuse compared to cases without chronic traumatic encephalopathy pathology. Understanding the frequency of chronic traumatic encephalopathy pathology in a large autopsy cohort with diverse exposure backgrounds provides a baseline for future prospective studies assessing the epidemiology and public health impact of chronic traumatic encephalopathy and sports‐related repetitive head trauma.

Is Return To Play At 6 Months After Latarjet Safe? A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group Cohort Study

Objectives: The Latarjet procedure is the becoming increasingly popular for the treatment of young athletes with recurrent instability. Earlier return to play protocols have been trialed with the thought that one is primarily waiting on bone healing. However, the impact of post-operative range of motion (ROM) and strength must be considered as well. Return to play has traditionally been accepted at 6 months post-operatively, but it is unknown what percentage of athletes achieve full strength and range of motion at that point. The purpose of this study was to 1) To evaluate rates of return of full strength and range of motion at 6 months after Latarjet, and 2) determine whether rates of results vary by percent bone loss, subscapularis split versus tenotomy, or athlete status (contact or overhead). Methods: Ten participating sites throughout the United States enrolled patients in a multicenter prospective cohort study. Sixty-five athletes met inclusion criteria (mean age 24.5 SD 8.2; 59 male, 6 female) and underwent Latarjet procedure for anterior instability (19/65 (29%) primary operation, 46/65 (71%) had a prior failed anterior stabilization). All participated in either contact sports (83%) and/or overhead sports (37%). Regarding anterior glenoid bone loss, 10% had <10% bone loss, 55% had 11-20%, and 35% had 21-30%. The Latarjet procedure was performed with either subscapularis tenotomy (64%) or split (36%). Strength and range of motion were assessed pre-operatively and at 6 months after surgery. Return to play (RTP) criteria were defined as full strength as well as less than 20 degrees side-to-side ROM deficits in all planes. The independent likelihood of strength and motion RTP criteria at 6 months for percent bone loss as well as subscapularis tenotomy vs split was assessed with multivariate logistic regression modeling with adjustment as needed for age, sex, preoperative strength/motion, number of prior dislocations, and participation in contact versus overhead sports. Results: 45% of patients failed to meet one or more return to play criteria: 9% failed for persistent weakness and 39% for ≥ 20 degree side to side loss of motion. All patients with loss of motion had ≥ 20 degree external rotation (ER) deficits either with elbow at side (88%) or at 90 degrees abduction (44%). There was no difference in achieving RTP criteria at 6 months between subscapularis split versus tenotomy either for strength (p=0.89) or range of motion (p=0.53). Contact athletes had a 53% RTP rate while overhead athletes had a 67% passage rate (p=0.17). Pre-operative weakness was not significantly predictive of post-operative weakness (p=0.13), and pre-operative external rotation was not predictive of post-operative ER deficits (p=0.16). Percent bone loss was not predictive of side-to side post-operative ROM deficits or weakness (p>0.20 all planes of motion). No other predictors for failure to meet RTP criteria at 6 months were identified. Conclusion: A large percentage of athletes do not have full return of strength and range of motion at 6 months following Latarjet procedure. Further consideration may be warranted prior to releasing these athletes to contact sports.

Contact sport participation and chronic traumatic encephalopathy are associated with altered severity and distribution of cerebral amyloid angiopathy.

Cerebral amyloid angiopathy (CAA) consists of beta-amyloid deposition in the walls of the cerebrovasculature and is commonly associated with Alzheimer's disease (AD). However, the association of CAA with repetitive head impacts (RHI) and with chronic traumatic encephalopathy (CTE) is unknown. We evaluated the relationship between RHI from contact sport participation, CTE, and CAA within a group of deceased contact sport athletes (n = 357), a community-based cohort (n = 209), and an AD cohort from Boston University AD Center (n = 241). Unsupervised hierarchal cluster analysis demonstrated a unique cluster (n = 11) with increased CAA in the leptomeningeal vessels compared to the intracortical vessels (p < 0.001) comprised of participants with significantly greater frequencies of CTE (7/11) and history of RHI. Overall, participants with CTE (n = 251) had more prevalent (p < 0.001) and severe (p = 0.010) CAA within the frontal leptomeningeal vessels compared to intracortical vessels. Compared to those with AD, participants with CTE had more severe CAA in frontal than parietal lobes (p < 0.001) and more severe CAA in leptomeningeal than intracortical vessels (p = 0.002). The overall frequency of CAA in participants with CTE was low, and there was no significant association between contact sport participation and the presence of CAA. However, in those with CAA, a history of contact sports was associated with increased CAA severity in the frontal leptomeningeal vessels (OR = 4.01, 95% CI 2.52-6.38, p < 0.001) adjusting for AD, APOE ε4 status, and age. Participants with CAA had increased levels of sulcal tau pathology and decreased levels of the synaptic marker PSD-95 (p's < 0.05), and CAA was a predictor of dementia (OR = 1.75, 95% CI 1.02-2.99, p = 0.043) adjusting for age, sex, and comorbid pathology. Overall, contact sport participation and CTE were associated with more severe frontal and leptomeningeal CAA, and CAA was independently associated with worse pathological and clinical outcomes.

Mild Chronic Traumatic Encephalopathy Neuropathology in People With No Known Participation in Contact Sports or History of Repetitive Neurotrauma.

It has been asserted that chronic traumatic encephalopathy (CTE) pathology is only present in former athletes and others who have been exposed to repetitive concussions, subconcussive blows, or both. We hypothesized that CTE pathology would be present in men who had no known history of repetitive neurotrauma. Comprehensive medical record reviews and health surveys completed by a family member were available for the 8 men in this case series, none of whom had known exposure to repetitive neurotrauma but 2 of whom had a history of traumatic brain injury (TBI). Postmortem tissue was immunostained for hyperphosphorylated tau (p-tau) to assess for CTE pathology, Braak stage, and aging-related p-tau. The neuropathologist was blind to age, personal history, and clinical history. Six of the 8 cases (75%) showed p-tau in neurons, astrocytes, and cell processes around small blood vessels in an irregular pattern at the depths of the cortical sulci. The changes were focal and limited in terms of overall extent, and some of the cases had a clearer pattern of pathology and some could be considered equivocal. Two of the 8 cases had a history of TBI and one of them showed CTE pathology. Five of the 6 cases with no known history of neurotrauma appeared to meet consensus criteria for CTE. This study adds to the emerging literature indicating that CTE pathology is present in people not known to have experienced multiple concussions or subconcussive blows to the head.

Previous Concussion History Influences Health-related Quality Of Life Among Collegiate Student-athletes: Baseline Findings From The Active Rehab Study

Prior concussion history is posited to influence many outcomes. Understanding how concussion history affects quality of life may identify student-athletes needing intervention and those predisposed to other conditions. PURPOSE: To examine how prior concussion history influences college athletes’ pre-season baseline health-related quality life (HRQOL). METHODS: Student-athletes (n = 1599) from six Canadian and US college institutions and 24 college sports, completed a comprehensive concussion baseline assessment including an HRQOL evaluation (PROMIS-29, Neuro-QOL Fatigue, and Neuro-QOL Cognition Scales). The primary predictor was concussion history and covariates included age, sex, BMI, and contact sport participation. Primary outcomes were Anxiety, Physical Function, Depression, Sleep Disturbance, Social Role/Activities, Pain Interference, Pain Intensity, Cognition, and Neuro-related Fatigue raw scores. Linear regression models clustered on study site using generalized estimating equations examined the association between concussion history and HRQOL outcomes. RESULTS: Analysis was limited to 1509 (94%) participants with complete outcome and covariate data [538 females (35.6%); median age = 19 years (range: 18-27); 553 (36.7%) with 1+ prior concussions); 1154 (76.5%) played a contact sport]. Concussion history, adjusted for age, sex, BMI, and contact sport participation, were associated with greater anxiety, sleep disturbance, depressive feelings, fatigue, and worse cognition function. However, these differences were mostly minor. Clinically meaningful mean differences (MD) suggest those with multiple concussions report worse cognitive function (MD=-1.2; 95%CI: -2.4, -0.1 for 3+ vs 0 concussions; MD=-1.1, 95% CI:-2.3, 0.1 for 2 vs. 0 concussions) and greater neuro-related fatigue (MD=1.3, 95% CI: -0.1, 2.7 for 3+ vs 0 concussions; MD=0.9, 95% CI: 0.1, 1.7 for 2 vs 0 concussions). CONCLUSIONS: After controlling for covariates, these data suggest that following primary recovery, those with prior concussions may exhibit increased cognitive and fatigue related complaints. These residual effects may confound incident concussion assessments, particularly when pre-season baseline measures are not available. Supported in part by a grant from the National Football League

Multiple Subscapularis Tendon Sign: A New Risk Factor for Recurrence After Arthroscopic Anterior Shoulder Instability Surgery.

Background:Being able to predict recurrence after the treatment of shoulder instability would be helpful in planning the appropriate treatment.Purpose:To define the multiple subscapularis tendon sign (MSTS) as a novel anatomic variant and a possible risk factor for the recurrence of shoulder instability after anterior stabilization and to evaluate it, together with the other risk factors as described in the literature.Study Design:Case-control study; Level of evidence, 3.Methods:A total of 87 patients met the study criteria and underwent arthroscopic stabilization for anterior shoulder instability. The MSTS was evaluated in this study group. Age, sex, hand dominance, number of preoperative shoulder dislocations, history of overhead or contact sports participation, type of labral lesion, number of anchors used in surgery, presence of the drive-through sign, presence of the MSTS, Oxford Shoulder Score results, and the association of these parameters with recurrence were assessed. The mean follow-up time was 81.0 ± 27.9 months (range, 48-139 months).Results:Nine (10.3%) patients experienced recurrent instability. The presence of the MSTS (P = .009), existence of an anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion (P = .04), and history of overhead or contact sports participation (P = .04) were significant risk factors for recurrence. The recurrence rates were as follows: 30.7% with the MSTS; 40% with the MSTS and an ALPSA lesion; and 75% with the MSTS, an ALPSA lesion, and a history of overhead or contact sports participation.Conclusion:The MSTS is a variation of the anterior shoulder joint capsule. It is a sign of capsular insufficiency or thinning, which may be a risk factor for recurrence after anterior stabilization. Considering the low success rates of anterior capsulolabral repair in patients participating in overhead or contact sports, especially when an ALPSA lesion is present, encountering the MSTS during surgery in this at-risk group may be an indicator for the surgeon to choose the surgical procedure more carefully.

Football’s InfluencE on Lifelong health and Dementia risk (FIELD): protocol for a retrospective cohort study of former professional footballers

IntroductionIn the past decade, evidence has emerged suggesting a potential link between contact sport participation and increased risk of late neurodegenerative disease, in particular chronic traumatic encephalopathy. While there remains...

Youth Exposure to Repetitive Head Impacts From Tackle Football and Long-term Neurologic Outcomes: A Review of the Literature, Knowledge Gaps and Future Directions, and Societal and Clinical Implications

Youth participation in contact and collision sports, particularly tackle football, is associated with exposure to repetitive head impacts during a time period when tremendous brain maturation is occurring. Accumulating evidence suggests that exposure to repetitive head impacts from youth tackle football may increase vulnerability to long-term cognitive, neuropsychiatric, and neurologic disturbances. There are limitations to the current literature and conflicting findings exist. Nonetheless, participation in youth football has become a cause of concern to clinicians, scientists, politicians, coaches, parents, and children. The objective of this paper is to review the literature on the long-term cognitive, neuropsychiatric, and neurologic outcomes associated with participation in youth contact and collision sports, with a focus on tackle football. We provide an overview of the empirically derived framework that has served as the foundation for the investigation of youth tackle football and neurologic outcomes. The extant research studies on age of first exposure to tackle football and later-life cognitive and neuropsychiatric functioning, as well as structural brain changes are reviewed. We discuss the limitations of the current evidence, suggest future directions, and conclude with our opinions on societal and clinical implications.

Prevention of Concussion

Concussion is a common pediatric problem, and the best point of intervention would be to prevent a concussion from occurring. Unfortunately, information in this area has inconsistent support for the various methods that have been attempted. In infants, concussions are typically related to safety hazards in the environment and attempts to make the environment safer have resulted in decreased injuries over time. Toddlers also face environmental hazards that are slightly different in light of their increased mobility. School-aged children and adolescents primarily sustain concussions in the course of participation in organized contact sports. Although much research has been devoted to protective equipment, there is not a clearly effective piece of equipment that prevents concussions. Some effect has been demonstrated with changes in rules and policy that limit or eliminate certain kinds of dangerous contact. Research is still being performed to adequately evaluate methods that are already being used, as well as to find new methods in the future that may help protect today's children from concussions.

Risk Factors for Lateral Meniscus Posterior Root Tears in the Anterior Cruciate Ligament–Injured Knee: An Epidemiological Analysis of 3956 Patients From the SANTI Study Group

Background: Lateral meniscus posterior root tears (LMPRTs) result in loss of hoop forces and significant increases in tibiofemoral contact pressures. Preoperative imaging lacks reliability; therefore, holding an appropriate index of suspicion, based on the epidemiology of and risk factors for LMPRT, may reduce the rate of missed diagnoses. Purpose: The primary objectives of this study were to evaluate the incidence of and risk factors for lateral meniscus root lesions in a large series of patients undergoing anterior cruciate ligament (ACL) reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: All patients who underwent primary or revision ACL reconstruction by a single surgeon between January 2011 and April 2018 were considered for study eligibility. From this overall population, all patients who underwent repair of an LMPRT were identified. The epidemiology of LMPRT was defined by the incidence within the study population, stratified by key demographic parameters. Potentially important risk factors for the presence of LMPRT were evaluated in multivariate logistic regression analysis. Results: A total of 3956 patients undergoing ACL reconstruction were included in the study. An LMPRT was identified and repaired in 262 patients (6.6%). Multivariate analyses demonstrated that significant risk factors for LMPRT included a contact sports injury mechanism (7.8% incidence with contact sport mechanism vs 4.5% with noncontact mechanism; odds ratio, 1.69; 95% CI, 1.266-2.285; P < .001) and the presence of a medial meniscal tear (7.9% incidence with medial meniscal tear vs 5.8% without; odds ratio, 1.532; 95% CI, 1.185-1.979; P < .001). Although the incidence of LMPRT in male patients (7.3%) was higher than in females (4.8%), this was not significant in multivariate analysis (P = .270). Patient age, revision ACL reconstruction, and a preoperative side-to-side laxity difference ≥6 mm were not significant risk factors for LMPRT. Conclusion: The incidence of LMPRT was 6.6% in a large series of patients undergoing ACL reconstruction. Participation in contact sports and the presence of a concomitant medial meniscal tear were demonstrated to be important independent risk factors. Their presence should raise the index of suspicion for this injury pattern.

Concussions in High School Sports in the Eastern Panhandle of West Virginia 2008-2017

The incidence and prevalence of sport-related concussion has increased over the past decade as a result of an increase in athletic participation, improved diagnostic methods, and an overall increased awareness of the symptoms and signs of concussions. This is a retrospective study identifying high school athletes in the Eastern Panhandle of West Virginia who participated in baseline and post-concussion neurocognitive ImPACT testing from 2008-2017. A total of p40 unique first post injury tests were performed, and a total of 9,850 unique baseline tests were perlormed. The athletes were baseline tested at the beginning of their freshman and junior years. New students and any student who had had a concussion in the previous year were tested prior to starting, their respective sport season. The number of post-concussion tests was compared to the number of baseline tests and stratified each year by age, sex, and sport. Comparing our findings with the incidence by sport reported in the medical literature demonstrated that the same sports identified as being the highest and lowest risk were generally congruent with the sports reported to be the highest and lowest risk in two large literature reviews » B. The notable exception was cheerleading; our study found it to be among the sports with a higher incidence of concussion. A review of the literature demonstrated that cheerleaders, like participants in other contact sports, are at significant risk for concussion. Previously concussion rates in cheerleading bad been reported to be relatively low (4- 6% of cheerleading injuries) compared to other injuries and compared to concussion rates in other sports. However, concussions were noted to be the most common cheerleading injury, accounting for 31.1% of injuries. " and also reported that the number and rate of cheerleading related concussions had increased by 290% from 2001 to 2012.

Elite athletes and anticoagulant therapy: an intermittent dosing strategy.

Traditionally, the athlete who requires long-term anticoagulation has been told to forgo participation in contact and collision sports. However, a strategy of short-term interruption of anticoagulant therapy may be designed for some athletes, allowing them return to full athletic activity. A personalized pharmacokinetic/pharmacodynamic study of a direct oral anticoagulant (DOAC) may allow athletic participation when plasma drug concentration is minimal and resumption of treatment after the risk of bleeding sufficiently normalizes. Scientific data and uncertainties regarding this approach, as well as practical challenges in the implementation, will be discussed.

Cerebral Autoregulation Is Disrupted Following a Season of Contact Sports Participation.

Repetitive subconcussive head impacts across a season of contact sports participation are associated with a number of deficits in brain function. To date, no research has investigated the effect of such head impact exposure on dynamic cerebral autoregulation (dCA). To address this issue, 179 elite, junior-level (age 19.6 ± 1.5 years) contact sport (ice hockey, American football) athletes were recruited for pre-season testing. Fifty-two non-concussed athletes returned for post-season testing. Fifteen non-contact sport athletes (age 20.4 ± 2.2) also completed pre- and postseason testing. dCA was assessed via recordings of beat-by-beat mean arterial pressure (MAP) and middle cerebral artery blood velocity (MCAv) using finger photoplethysmography and transcranial Doppler ultrasound, respectively, during repetitive squat-stand maneuvers at 0.05 and 0.10 Hz. Transfer function analysis was used to determine Coherence (correlation), Gain (response amplitude), and Phase (response latency) of the MAP-MCAv relationship. Results showed that in contact sport athletes, Phase was reduced (p = 0.027) and Gain increased (p < 0.001) at post-season compared to pre-season during the 0.10 Hz squat-stand maneuvers, indicating cerebral autoregulatory impairment in both the latency and magnitude of the response. Changes in Phase were greater in athletes experiencing higher numbers and severity of head impacts. By contrast, no changes in dCA were observed in non-contact sport controls. Taken together, these results demonstrate that repetitive subconcussive head impacts occurring across a season of contact sports participation are associated with exposure-dependent impairments in the cerebrovascular pressure-buffering system capacity. It is unknown how long these deficits persist or if they accumulate year-over-year.

Availability of Concussion Information in Spanish for Parents of Youth Athletes.

All but one U.S. state has passed legislation requiring that concussion information be provided to parents of youth participants in school-sponsored sport. Such information should be accessible and easily understood if it is to be used by parents to make informed decisions regarding their children's health and safety. Accessing and understanding information about concussion may be challenging for parents who lack fluency in English. The current study sought to describe the extent and nature of Spanish-language concussion information available on the websites of U.S. public high school athletic associations. We also examined information provided by leading youth sports and health organizations as well as the top U.S. children's hospitals. We sought to quantify the proportion of these websites with Spanish-language translation of concussion education materials and describe the readability, accessibility, and completeness of these translations. Only one quarter of the websites examined contained any concussion information in Spanish, and none of these websites offered a mirrored Spanish-language translation. Spanish information was also difficult to access, with the search process requiring English-language ability. Finally, the readability of the concussion information in both English and Spanish was higher than recommended guidelines. Our findings suggest that non-English-speaking parents may be inadequately informed about concussion because translation of concussion educational materials is absent, incomplete, or hard to access. This raises questions about whether they are able to provide informed consent for their children's participation in contact sport and suggests the need for improved translation of such informational materials.

Lewy Body Pathology and Chronic Traumatic Encephalopathy Associated With Contact Sports.

Traumatic brain injury has been associated with increased risk of Parkinson disease and parkinsonism, and parkinsonism and Lewy body disease (LBD) can occur with chronic traumatic encephalopathy (CTE). To test whether contact sports and CTE are associated with LBD, we compared deceased contact sports athletes (n = 269) to cohorts from the community (n = 164) and the Boston University Alzheimer disease (AD) Center (n = 261). Participants with CTE and LBD were more likely to have β-amyloid deposition, dementia, and parkinsonism than CTE alone (p < 0.05). Traditional and hierarchical clustering showed a similar pattern of LBD distribution in CTE compared to LBD alone that was most frequently neocortical, limbic, or brainstem. In the community-based cohort, years of contact sports play were associated with neocortical LBD (OR = 1.30 per year, p = 0.012), and in a pooled analysis a threshold of >8 years of play best predicted neocortical LBD (ROC analysis, OR = 6.24, 95% CI = 1.5-25, p = 0.011), adjusting for age, sex, and APOE ɛ4 allele status. Clinically, dementia was significantly associated with neocortical LBD, CTE stage, and AD; parkinsonism was associated with LBD pathology but not CTE stage. Contact sports participation may increase risk of developing neocortical LBD, and increased LBD frequency may partially explain extrapyramidal motor symptoms sometimes observed in CTE.

Risk Factors for Recurrent Shoulder Instability after Arthroscopic Revision Anterior Stabilization

Objectives:Individuals that fail arthroscopic anterior stabilization of the shoulder represent a unique and challenging patient population. To date, there have been few large studies that have investigated failure rates following arthroscopic revision anterior stabilization (ARAS) for failed primary arthroscopic stabilization. This study aims to determine the risk factors for recurrence of shoulder instability following ARAS. We hypothesized that male gender, younger age, participation in contact sports, significant glenoid and/or humeral bone loss, ligamentous laxity, and worker’s compensation would increase the risk of revision failure.Methods:Patients who underwent ARAS after a failed arthroscopic primary Bankart repair and had a minimum of 2-year follow-up were included in this study. Glenoid and humeral bone loss were quantitatively assessed using pre-operative T1-weighted magnetic resonance arthrograms to determine if the lesions were on- or off-track. Failure was defined as a recurrent dislocation or subluxation. Chi-square test and t-test were used to compare demographical and surgical parameters between failure and non-failure groups. The significance level was set to 0.05.Results:Sixty-five patients [age at revision = 26 years (range, 15 - 57), 44 (68%) male] met the inclusion criteria. The mean follow-up time was 4.7 years (range, 2 - 10.8). Twenty-seven patients (42%) had a failed revision at a mean time of 2.3 years (range, 0.2 - 6.1). Age less than 22 years old, ligamentous laxity, the presence of an off-track lesion, and a concomitant superior labral anterior to posterior were significantly associated with revision failure (p < 0.05) (Table 1). No difference was observed in the size of glenoid defect between failure and non-failure groups (14.1% ± 4.4% vs. 13.7% ± 3.9%, p = 0.762). The width and depth of the Hill-Sachs lesions were not significantly different between groups (width: 15.3 ± 5.1 mm vs. 14.2 ± 4.8 mm, p = 0.432; depth: 4.2 ± 2.3 mm vs. 3.5 ± 1.8 mm, p = 0.244). On multivariate analysis, only the presence of an off-track lesion, age less than 22 years, and ligamentous laxity were independent predictors for recurrent instability (OR = 8.9, p = 0.022; OR = 5.4, p = 0.028; OR = 7.8, p = 0.031, respectively).Conclusion:The failure rate of arthroscopic revision anterior stabilization was 42% with off-track lesions, age less than 22 years, and ligamentous laxity independent risk factors for recurrent instability. While ARAS may be a viable treatment option in the appropriate setting, our study suggests that considerable thought should be exercised before utilizing this approach given the significant number of patients who suffered recurrent instability at greater than 2-years follow-up. For young patients with off-track lesions and/or evidence of ligamentous laxity on physical exam, strong consideration should be given to either an open Bankart repair, a bony augmentation procedure such as a Bristow-Latarjet procedure, or an arthroscopic revision approach with additional augmentation such as a remplissage.Table 1.Parameters Tested Against Arthroscopic Revision Anterior Stabilization FailureaParameterRevision FailureNo Revision FailureORp-value Age at revision <22y 16/27 (59%)13/38 (34%)2.80 0.045 Ligamentous Laxity 10/27 (37%)5/38(13%)3.88 0.024 Off-Track Lesion 10/22 (45%)4/36(11%)6.67 0.003 SLAP Tear 11/27 (41%)6/38 (16%)3.67 0.024 Male Gender17/27 (63%)27/38 (71%)0.690.492BMI> 30 kg/m2 3/24 (13%)3/27 (11%)1.141.000Dominant Side Instability20/27 (74%)23/38 (61%)1.860.255Bilateral Anterior Instability3/27(11%)7/38 (18%)0.550.503Workers’ Compensation3/27 (11%)9/38 (24%)0.400.331Athletes12/27 (44%)17/38 (45%)0.990.981Contact sports9/12 (75%)12/17(71%)1.251.000Competitive Level3/12 (25%)3/17 (18%)1.560.699Open Primary Bankart Repair2/23 (9%)4/35(11%)0.741.000Traumatic Repair Failure7/18 (39%)16/35(46%)0.760.635Time from Failure to Revision < 1 y21/27 (78%)31/38(82%)0.790.706Total Number of Anchors ≤ 36/20 (30%)10/30(33%)0.860.804Number of Anteroinfaior Anchors ≤ 314/20(70%)19/30(63%)1.350.626Label Tear > 120°13/20(65%)20/30(67%)0.930.903 aData expressed as count/number of available cases (%). Competitive level is defined as collegiate or higher. Bold denotes significance. SLAP, superior labrum anterior and posterior; BMI, body mass index; OR, odds ratio.

Current practice patterns for postoperative activity restrictions in children

BackgroundPostoperative activity restrictions are designed to prevent undue stress on a recent repair and minimize the risk of surgical complication, however, there is little evidence to support certain restrictions in clinical practice. For the pediatric population, there is a paucity of formal evaluations of postoperative activity restrictions, and little is known about current practice patterns among pediatric surgeons. This study aimed to describe national practice patterns of pediatric surgeons for postoperative activity recommendations following three common general surgical procedures. MethodsA 7-item survey was sent to all American Pediatric Surgical Association (APSA) members regarding surgeon practice of recommended activity restrictions for school attendance, participation in playground or gym, participation in contact sports, and heavy lifting in children following 3 procedures: exploratory laparotomy, laparoscopic appendectomy, and inguinal hernia repair. Information on type and duration of clinical practice was also collected for each surgeon. Descriptive and bivariate analyses were performed. ResultsThe survey was completed by 293 pediatric surgeons for a response rate of 28.9%. There was wide national variability in the recommended activity restrictions for children <12 years old among pediatric surgeons. Following laparoscopic appendectomy, 30.7%, 51.9% and 47.8% of surgeons recommends restriction of gym, contact sports, and heavy lifting for 2–3 weeks respectively, but 26.7%, 19.8%, and 22.2% do not recommend any restriction whatsoever of these three activities. Following inguinal hernia repair, 31.7%, 49.1% and 44.4% of surgeons recommend restriction of gym, contact sports, and heavy lifting for 2–3 weeks, but 30.8%, 30.8%, and 29.2% do not recommend any restriction of these three activities. Only 22% of surgeons change their activity restriction recommendations for children ≥12 years old, this decision was not associated with surgeon years in practice or type of practice. ConclusionsThere is considerable variability in surgeon recommendations for activity restrictions following three general surgery procedures in children. While activity restrictions are rooted in the physiology of wound healing, there is little evidence to support the benefit of these restrictions in clinical practice. In addition, activity restriction may have unintended deleterious effects on a child's psychosocial well-being and quality of life. Further investigation should be pursued to understand the utility of activity restrictions in children and their impact on clinical outcomes and patient quality of life. Type of StudyTreatment study. Level of EvidenceLevel V, expert opinion.

Fluctuations in blood biomarkers of head trauma in NCAA football athletes over the course of a season.

Repetitive subconcussive head trauma is a consequence of participation in contact sports and may be linked to neurodegenerative diseases. The degree of neurological injury caused by subconcussive head trauma is not easily detectible, and this injury does not induce readily identifiable clinical signs or symptoms. Recent advancements in immunoassays make possible the detection and quantification of blood biomarkers linked to head trauma. Identification of a blood biomarker that can identify the extent of neurological injury associated with subconcussive head trauma may provide an objective measure for informed decisions concerning cumulative exposure to subconcussive head trauma. The purpose of the current study was to examine changes in the blood biomarkers of subconcussive head trauma over the course of an American football season. Thirty-five National Collegiate Athletic Association (NCAA) American football athletes underwent blood sampling throughout the course of a football season. Serial samples were obtained throughout the 2016 season, during which the number and magnitude of head impacts changed. Blood samples were analyzed for plasma concentrations of tau and serum concentrations of neurofilament light polypeptide (NF-L). Athletes were grouped based on their starter status, because athletes identified as starters are known to sustain a greater number of impacts. Between-group differences and time-course differences were assessed. In nonstarters, plasma concentrations of tau decreased over the course of the season, with lower values observed in starters; this resulted in a lower area under the curve (AUC) (starters: 416.78 ± 129.17 pg/ml/day; nonstarters: 520.84 ± 163.19 pg/ml/day; p = 0.050). Plasma concentrations of tau could not be used to discern between starters and nonstarters. In contrast, serum concentrations of NF-L increased throughout the season as head impacts accumulated, specifically in those athletes categorized as starters. The higher serum concentrations of NF-L observed in starters resulted in a larger AUC (starters: 1605.03 ± 655.09 pg/ml/day; nonstarters: 1067.29 ± 272.33 pg/ml/day; p = 0.007). The AUC of the receiver operating characteristic curve analyses displayed fair to modest accuracy to identify athletes who were starters with the use of serum NF-L following periods of repetitive impacts. The different patterns observed in serum NF-L and plasma tau concentrations provide preliminary evidence for the use of blood biomarkers to detect the neurological injury associated with repetitive subconcussive head trauma. Although further investigation is necessary, such findings might lay the foundation for the further development of an objective measure for the detection of neurological injury caused by subconcussive head trauma.

High prevalence of prior contact sports play and concussion among orthopedic and neurosurgical department chairs.

OBJECTIVE Increased understanding of the consequences of traumatic brain injury has heightened concerns about youth participation in contact sports. This study investigated the prevalence of high school and collegiate contact sports play and concussion history among surgical department chairs. METHODS A cross-sectional survey was administered to 107 orthopedic and 74 neurosurgery chairs. Responses were compared to published historical population norms for contact sports (high school 27.74%, collegiate 1.44%), football (high school 10.91%, collegiate 0.76%), and concussion prevalence (12%). One-proportion Z-tests, chi-square tests, and binary logistic regression were used to analyze differences. RESULTS High school contact sports participation was 2.35-fold higher (65.3%, p < 0.001) for orthopedic chairs and 1.73-fold higher (47.9%, p = 0.0018) for neurosurgery chairs than for their high school peers. Collegiate contact sports play was 31.0-fold higher (44.7%, p < 0.001) for orthopedic chairs and 15.1-fold higher (21.7%, p < 0.001) for neurosurgery chairs than for their college peers. Orthopedic chairs had a 4.30-fold higher rate of high school football participation (46.9%, p < 0.001) while neurosurgery chairs reported a 3.05-fold higher rate (33.3%, p < 0.001) than their high school peers. Orthopedic chairs reported a 28.1-fold higher rate of collegiate football participation (21.3%, p < 0.001) and neurosurgery chairs reported an 8.58-fold higher rate (6.5%, p < 0.001) compared to their college peers. The rate at which orthopedic (42.6%, p < 0.001) and neurosurgical (42.4%, p < 0.001) chairs reported having at least 1 concussion in their lifetime was significantly higher than the reported prevalence in the general population. After correction for worst possible ascertainment bias, all results except high school contact sports participation remained significant. CONCLUSIONS The high prevalence of youth contact sports play and concussion among surgical specialty chairs affirms that individuals in careers requiring high motor and cognitive function frequently played contact sports. The association highlights the need to further examine the relationships between contact sports and potential long-term benefits as well as risks of sport-related injury.