Risk Of Subsequent Injury Research Articles

A Longitudinal Study of the Relationship Between Lower Extremity Field Tests and Medial Elbow Injuries in Elementary School Baseball Players

This study aimed to examine prospectively the relationship between the deep squatting test and medial elbow injuries in elementary school baseball players and to determine the usefulness of the lower extremity field test in throwing injuries. The participants were 254 players who had participated in preseason medical checkups in both 2019 and 2020 and had no problems with the 2019 medical checkups. The evaluation parameters included ultrasonography examination, physical examination, and three types of deep squatting tests. The success rate of deep squatting tests was significantly lower in the injured group than in the non-injured group in the medial elbow injuries. By the difficulty level, the backward test in the deep squatting test was more likely to predict medial elbow injuries than the forward and middle tests. Furthermore, there was a significant difference in the squatting test and medial elbow injuries by grades. In conclusion, this is the first prospective study to provide evidence that the deep squatting tests, classified by difficulty level, can predict the risk of subsequent medial elbow injuries in elementary school players. The deep squatting test may be useful as a field test for lower extremity flexibility that can be performed by athletes and instructors, as it can predict the risk of subsequent medial elbow injuries.

National basketball association slam dunk contest participation does not lead to increased injury risk or adversely affect player performance

Background: The National Basketball Association (NBA) Slam Dunk Contest has declined in popularity in recent years, in large part due to a lack of star-player participation relative to the NBA All Star Game. The purpose of the current study is to evaluate the effect of NBA Slam Dunk Contest participation on subsequent injury risk and player performance. Methods: Participants from twenty NBA Slam Dunk Contests (2000-2019) were identified and matched to a control group consisting of same-year All-Star Game players. Injury data and performance data concerning all major offensive and defensive statistical categories was obtained from publicly available databases. Injury rates and season-long statistical performances were compared between groups both before and after the All-Star Game/Dunk Contest. Logistic regression was used to identify independent risk factors for injury in the second portion of the NBA season. Results: There were 88 players in each group. Injury rates in the second portion of the season were not statistically different between the groups. The dunk contest group did not demonstrate a statistical decline in any of the second half performance metrics. When compared to the control group, no statistically significant second-half differences were noted other than a slight increase in points-per-minute in the dunk contest group (5.6%±20.3% vs. 0.0%±15.8% P=0.04). Conclusions: Participation in the NBA Slam Dunk Contest did not lead to an increased risk for injury or a decline in statistical production when compared to All-Star game players.

Clinical Measures Associated with Subsequent Injury after Adolescent Concussion: A Prospective Cohort Study

ABSTRACT Purpose To examine associations between clinical measures (self-reported and clinician-administered) and subsequent injury rates in the year after concussion return to play (RTP) among adolescent athletes. Methods We performed a prospective, longitudinal study of adolescents ages 13-18 years. Each participant was initially assessed within 21 days of concussion and again within 5 days of receiving RTP clearance from their physician. Participants completed self-report measures: the Pittsburgh Sleep Quality Index (PSQI) and Tampa Scale of Kinesiophobia (TSK), and clinician-administered measures: single and dual-task tandem gait (TG) and reaction time (RT; simple and clinical) assessments. They then completed monthly surveys for a year after RTP which assessed exposure to injury (sport participation) and subsequent injuries (musculoskeletal or concussions) sustained. We used Poisson regression models to calculate injury rate ratios with number of subsequent injuries sustained as the outcome, adjusted for RTP clearance time and competitive exposures for each measure. Results 41 participants were included (age = 15.5±1.3 years, 56% female, 9.6±4.6 days post-concussion; 38.0±31.5 days to RTP). A higher injury rate per athletic exposure was observed for simple RT≥505 ms vs <505 ms (injury rate ratio = 3.22; 95% confidence interval = 1.56, 7.12; p = 0.002). Injury rates did not significantly differ by PSQI or TSK scores, single/dual-task TG time, or clinical RT. Conclusions Simple reaction time may be one risk factor that is associated with higher rates of subsequent injury after adolescent concussion. A simple reaction time measure incorporated into a comprehensive concussion RTP assessment may identify some individuals at higher risk of subsequent injury in the year following concussion, though further research is needed to better understand this relationship.

How Athletic Swiss Patients Experience Their Return to Sports After Anterior Cruciate Ligament Reconstruction: Results from a Retrospective Self-Assessment.

Anterior cruciate ligament (ACL) ruptures are frequent injuries, especially in athletes. Return to sports after reconstruction of the ligament is a frequently debated topic and of high relevance for these patients. It is mostly achieved at 9-12 months post-surgery. However, the risk of subsequent knee injuries is high and psychological factors play an important role in the process and success of returning to sports. Little is known about patients' perception of their journey returning to sports. This study aims to fill the gap. The study aimed to include patients treated surgically for an ACL injury over 5 years at a specialized sports-medicine clinic. Patients were surveyed on the impact of the injury on their lives, their return to sports experience, and medical history. In total, 100 (of 474) patients aged 35.9 years responded. Within 5 years, 19% experienced a reoperation and 23% a new knee injury. Overall, 83% of patients returned to their main sport, 72% reached their pre-injury level. However, 45% reported at least one distinct or severe consequence of their ACL injury. The ability to return to sports had more impact on the perception of the course of treatment than the experience of new injuries or surgery. The rate of successful return to sports was comparable to previous reports despite a higher average age in this cohort. A successful return to sports seems to be a major determinant for the perception of impact from the injury and may be more important than the avoidance of repeat trauma.

Sports Injury Surveillance Systems: A Scoping Review of Practice and Methodologies.

Background: Injury prevention/reduction strategies are driven by data collected through injury surveillance systems. The aim of this review was to describe injury surveillance systems that are used for ongoing surveillance in either a professional or amateur sporting environment. This was an update to a review done in 2015 to determine the gaps in injury surveillance. Methods: A systematic search process of five databases (MEDLINE, CINAHL, EMBASE, SCOPUS and ProQuest) was used to discover published research that presented methodological data about the injury surveillance systems implemented by clubs and organisations for ongoing surveillance. Inclusion criteria centred on the population under surveillance and the ongoing nature of that activity. Data extracted and summarised included the level of athlete under surveillance, the data collection mechanism and the personnel involved, the injury definitions applied and the date and country of origin to provide a comprehensive picture of the systems. Results: A total of 21 systems were documented as being used in ongoing injury surveillance, with 57% of these exclusively in the professional/elite landscapes and 33% at the amateur level. Surveillance systems cater for one sport per athlete entry so there is a gap in research for multi-sport athletes at the amateur level, especially where there is no early specialisation in a multi-sport participation environment. Conclusions: Research in this area will lead to a better understanding of subsequent injury risk for multi-sport athletes who have a higher athlete exposure than single-sport athletes.

Subsequent musculoskeletal injury after concussion in National Football League players

ObjectiveTo assess whether National Football League (NFL) players diagnosed with a concussion have an increased risk of injury after return to football.MethodsA retrospective cohort study analysed the hazard of subsequent...

Differential neural mechanisms for movement adaptations following neuromuscular training in young female athletes with a history of sports-related concussion

Sports-related concussion (SRC) in adolescent athletes is associated with an increased risk of subsequent lower extremity injury. Neuromuscular training (NMT) has shown promise for reducing lower extremity injuries following SRC, however, neural adaptations in response to changes in lower extremity biomechanics following NMT in athletes with a history of SRC (HxSRC) remains poorly understood. Therefore, the purpose of this study was to identify changes in neural activity associated with lower extremity movement adaptations following a six-week NMT intervention in athletes with a HxSRC. Thirty-two right-hand/foot-dominant female adolescent athletes (16 with self-reported HxSRC, 16 age- and anthropometrically-matched controls) completed a bilateral leg press task with 3D motion analysis during functional magnetic resonance imaging (fMRI). Movement adaptations were defined as a change in frontal and sagittal plane range of motion (ROM) during the fMRI bilateral leg press task. Significant pre- to post-NMT reductions were observed in the non-dominant (left) mean frontal plane ROM. Whole-brain neural correlate analysis revealed that increased cerebellar activity was significantly associated with reduced mean left-knee frontal ROM for matched controls. Exploratory within group analyses identified neural correlates in the postcentral gyrus for the HxSRC group which was associated with reduced mean left-knee frontal plane ROM. These distinct longitudinal changes provide preliminary evidence of differential neural activity associated with NMT to support knee frontal plane control in athletes with and without a HxSRC.

Incidence of Subsequent Injuries Associated with a New Diagnosis of Benign Paroxysmal Positional Vertigo and Effects of Treatment: A Nationwide Cohort Study.

Background/Objectives: Benign paroxysmal positional vertigo (BPPV) is the most common cause of recurrent vertigo and the most common peripheral vestibular disorder. It is characterized by intense vertigo triggered by head and position changes. This study investigates the risk of subsequent injury in BPPV patients and the effects of treatment. Methods: A population-based retrospective cohort study was conducted using data from the Longitudinal Health Insurance Database 2005 in Taiwan. Patients with and without BPPV were identified between 2000 and 2017. The study outcomes were diagnoses of all-cause injuries. The Kaplan-Meier method determined the cumulative incidence rates of injury in both cohorts, and a log-rank test analyzed the differences. Cox proportional hazard models calculated each cohort's 18-year hazard ratios (HRs). Results: We enrolled 50,675 patients with newly diagnosed BPPV and 202,700 matched individuals without BPPV. During follow-up, 47,636 patients were diagnosed with injuries (13,215 from the BPPV cohort and 34,421 from the non-BPPV cohort). The adjusted HR for injury in BPPV patients was 2.63 (95% CI, 2.49-2.88). Subgroup analysis showed an increased incidence of unintentional and intentional injuries in BPPV patients (aHR 2.86; 95% CI, 2.70-3.13 and 1.10; 95% CI, 1.04-1.21, respectively). A positive dose-response relationship was observed with increasing BPPV diagnoses. Treatment with canalith repositioning therapy (CRT) or medications reduced the risk of injury slightly but not significantly (aHR, 0.78; 95% CI, 0.37-1.29, 0.88; 95% CI, 0.40-1.40, respectively). Conclusions: BPPV is independently associated with an increased risk of injuries. CRT or medications have limited effects on mitigating this risk. Physicians should advise BPPV patients to take precautions to prevent injuries even after treatment.

Impact of Weekly Training-Load Structure and Content on the Risk of Injury in Professional Rugby Union Match-Play.

Chéradame, J, Loursac, R, Piscione, J, Carling, C, Decq, P, and Jacqmin-Gadda, H. Impact of weekly training-load structure and content on the risk of injury in professional Rugby Union match-play. J Strength Cond Res 38(9): 1613-1619, 2024-The aim of this study was to investigate the impact of different components of daily training load during the week preceding the match on the risk of sustaining a match injury in professional rugby union. A cohort of 72 players from a single professional French club participated. Global positioning system-derived data including total distance (TD) and high-speed distance in addition to ratings of perceived effort (RPE) for both on- and off-pitch (gym-based strength conditioning work) training were collected for each training session over 3 seasons (2017-2020). The association between the daily measures of external and internal training load over the week preceding the day of the match (MD) and the subsequent risk of injury in match-play was estimated using a mixed-effects logistic model adjusted for contextual and individual factors. A total of 184 injuries were sustained in 128 matches (incidence: 81.2 injuries per 1,000 player hours). Higher RPE values for the strength conditioning session on MD-5 ( p < 0.001) and for the on-pitch session on MD-1 ( p = 0.04) were associated with an increased risk of injury in matches. On MD-2, a higher TD covered and that run at high speed (>MAS) were, respectively, associated with a higher ( p = 0.03) and lower risk ( p = 0.02) of injury in matches played. This study in professional rugby union shows that different components of external and internal load had varying influences on injury risk and particularly in relation to the day on which these were performed in the week leading up to the next match. At MD-2, training load favoring intensity rather than volume could reduce the risk of match-play injury.

Trunk and Lower Extremity Biomechanics in Female Athletes With and Without a Concussion History.

Athletes with a history of concussion are at a greater risk for lower extremity musculoskeletal injury. Female athletes may be at an even greater risk than male athletes. Previous researchers on postconcussion landing biomechanics have focused on the lower extremities, but the trunk plays a crucial role as an injury risk factor. To compare lower extremity and trunk biomechanics during jump-landing and cutting maneuvers between female athletes with and those without a concussion history. Cross-sectional study. Biomechanics laboratory. A total of 26 athletes (mean ± SD age = 19.0 ± 1.3 years, height = 1.68 ± 0.07 m, mass = 64.02 ± 6.76 kg, body mass index = 22.58 ± 1.97 kg/m2; median [interquartile range] time since most recent concussion = 37.5 months [25.0 months, 65.8 months]) with a concussion history and 38 athletes (age = 19.0 ± 1.1 years, height = 1.71 ± 0.08 m, mass = 64.72 ± 9.45 kg, body mass index = 22.14 ± 1.80 kg/m2) without a concussion history. Peak kinetics (vertical ground reaction force, vertical loading rate, external knee-abduction moment, and external knee-flexion moment) and kinematics (trunk-flexion angle, trunk lateral-bending angle, ankle-dorsiflexion angle, knee-flexion angle, knee-abduction angle, and hip-flexion angle) were obtained during the eccentric portion of jump-landing and cutting tasks. Separate 2 (group) × 2 (limb) between- and within-factors analyses of covariance were used to compare outcomes between groups. We covaried for time since the most recent concussion and the limb that had a history of musculoskeletal injury. Athletes with a concussion history displayed a greater peak knee-abduction angle in their nondominant limb than their dominant limb (P = .01, ηp2 = 0.107) and the nondominant limb of athletes without a concussion history (P = .02, ηp2 = 0.083) during jump landing. They also had less trunk lateral bending during cutting compared with athletes without a concussion history (P = .005, ηp2 = 0.126). Our results indicated landing biomechanics are different between female athletes with and those without a concussion history. This finding may be due to impairments in neuromuscular control postconcussion that may ultimately increase the risk of subsequent lower extremity injury, although further research is warranted given the cross-sectional nature of our study.

Delayed anterior cruciate ligament reconstruction and risk of meniscus injury: Exploring the safest delay interval.

The duration for which anterior cruciate ligament reconstruction (ACLR) can be delayed without resulting in a risk of subsequent meniscus injury has remained a debatable topic. The main purpose of this study was to determine the safest delay interval for a delayed ACLR. This retrospective study included all patients who underwent ACLR between January 2020 and January 2022. The patients were divided into four groups based on the delay interval: <3 months, 3-6 months, 6-12 months and >12 months. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score and Knee Injury and Osteoarthritis Outcomes Score (KOOS) at 1-year postoperatively. A total of 95 patients were included in this study. ACLR delay of 3-6 months was not associated with the risk of meniscus injury, while a delay of 6-12 months (odds ratio [OR] = 4.35; 95% confidence interval [CI] = 1.13-16.79; p = 0.031) and >12 months (OR = 10.68; 95% CI = 2.55-42.22; p = 0.001) was associated with a likelihood of developing meniscus injury. Meniscus injury risk increased by 12% for each month of ACLR delay (OR = 1.12; 95% CI = 1.04-1.22; p = 0.003). Regarding clinical outcomes at 1-year postoperatively, all groups exhibit the same clinical results. ACLR can be safely delayed up to 6 months after the initial injury. However, a delay for >6 months must be avoided, as it was found to significantly increase the likelihood of developing a meniscus injury. Level III, retrospective comparative study.

Playing surface and sport contact status modulate time to lower extremity musculoskeletal injury at a greater level than concussion history among collegiate student-athletes

ObjectivesWhile previous investigations have demonstrated a positive correlation between previous concussion and risk of subsequent lower extremity musculoskeletal injury (LEMSKI), the effect of sport- and patient-specific factors on time to injury has not been thoroughly described. This study's main objective was to evaluate the relationship between prior concussion and time to LEMSKI among a population of collegiate student-athletes. Secondary objectives were to evaluate the relationship between playing surface, sport contact status, and biologic sex on time to LEMSKI. We hypothesized that those with previous concussions, those competing on synthetic surfaces, and those competing in collision sports would experience decreased latency to LEMSKI overall. MethodsA retrospective observational analysis of National Collegiate Athletic Association (NCAA) Division I student-athletes was conducted utilizing a mixed linear model analysis with contrasts. Inclusion criteria included participation in the Pac-12 Health Analytics Program with a documented LEMSKI between 2017 and 2020. Exclusion criteria included concurrent concussion and LEMSKI, injury resulting in serious morbidity or mortality, and incomplete medical record. Participants were classified by whether they sustained a concussion prior to LEMSKI in each athletic season. ResultsOf 1179 athletes included, 1140 had no previous concussion and 37 had a previous concussion. There was no observed effect of previous concussion (F ​= ​0.038; p ​= ​0.846) on time to LEMSKI overall. Student-athletes competing on constructed surfaces sustained a subsequent LEMSKI 14.5 days sooner (SE ​= ​5.255; p ​= ​0.045), and those competing on organic surfaces sustained a subsequent LEMSKI 23.5 days sooner (SE ​= ​4.018; p ​< ​0.001) in the season than those competing on synthetic surfaces. Contact sport student-athletes sustained a subsequent LEMSKI 52.1 days sooner than collision sport student-athletes (SE ​= ​5.248; p ​< ​0.001), and limited contact sport student-athletes sustained a subsequent LEMSKI 42.29 days sooner than collision sport student-athletes (SE ​= ​4.463; p ​< ​0.001). There was no observed effect of biologic sex (F ​= ​0.602; p ​= ​0.438) on time to LEMSKI overall. ConclusionThere was no observed impact of concussion on time on LEMSKI overall in this collegiate athletic population. Contact sports were associated with decreased time to LEMSK, while synthetic surfaces were associated with increased time to LEMSKI in this population. There was no observed impact of biologic sex on time to LEMSKI. Level of evidenceCase-control, level of evidence III.

Muscle Pain Code: a novel tool for screening the risk of time-loss muscle injury in professional male football players

ABSTRACT Objective To investigate the association of a novel post-match muscle pain map, named Muscle Pain Code (MPC), with the risk of subsequent time-loss muscle injury in a cohort of professional football (soccer) players. Methods The MPC classifies pain in four codes: code 0, ‘no pain;’ code 1, ‘generalized muscle pain;’ code 2, ‘diffused site muscle pain;’ and code 3, ‘specific site muscle pain.’ Over four consecutive seasons, MPC was collected on the second post-match day and players were followed for occurrence of time-loss muscle injury over the next five days. Players exposed to at least 45 minutes in two consecutive matches within seven days were included as cases for analysis. Results Eighty players participated in the study. Of 1,656 cases analyzed, 229 resulted in time-loss muscle injuries. Only 2% of cases with codes 0 and 1 resulted in time-loss muscle injuries. Conversely, 63% and 78% of codes 2 and 3 were followed by time-loss muscle injuries, respectively. Compared with the reference scenario (i.e. code 0 on MPC), the risk of subsequent time-loss muscle injury was significantly higher when players recorded code 2 (odds ratio, 4.29; 95%CI, 3.62 to 4.96) or code 3 (odds ratio, 5.01; 95%CI, 4.05 to 5.98) on MPC, but not when they recorded code 1 (odds ratio = −0.27; 95%CI, 1.05 to 0.56). Conclusions Players experiencing well-outlined pain area on the second post-match day were more likely to incur a time-loss muscle injury in the subsequent days compared to those experiencing spreading pain or no pain.

Association between passing return-to-sport testing and re-injury risk in patients after anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis.

Inconsistent results have been obtained regarding the association between return-to-sport (RTS) testing and the risk of subsequent re-injury following anterior cruciate ligament reconstruction (ACLR). We therefore conducted a systematic review and meta-analysis to assess the potential association between passing of RTS and the risk of re-injury for patients after ACLR. This meta-analysis was registered in INPLASY with the registration number INPLASY202360027. The electronic databases MedLine, EmBase, and the Cochrane library were systematically searched to identify eligible studies from their inception up to September 2023. The investigated outcomes included knee injury, secondary ACL, contralateral ACL injury, and graft rupture. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the random-effects model. A total number of nine studies involving 1410 individuals were selected for the final quantitative analysis. We noted that passing RTS test was not associated with the risk of subsequent knee injury (OR: 0.95; 95% CI: 0.28-3.21; P = 0.929), secondary ACL injury (OR: 0.98; 95% CI: 0.55-1.75; P = 0.945), and contralateral ACL injury (OR: 1.53; 95% CI: 0.63-3.71; P = 0.347). However, the risk of graft rupture was significantly reduced (OR: 0.49; 95% CI: 0.33-0.75; P = 0.001). This study found that passing RTS test was not associated with the risk of subsequent knee injury, secondary ACL injury, and contralateral ACL injury, while it was associated with a lower risk of graft rupture. Thus, it is recommended that patients after ACLR pass an RTS test in clinical settings.

Load and recovery monitoring in Swiss top-level youth soccer players: Exploring the associations of a new web application-based score with recognised load measures

Load and recovery monitoring in Swiss top-level youth soccer players: Exploring the associations of a new web application-based score with recognised load measures

Sport Type and Risk of Subsequent Injury in Collegiate Athletes Following Concussion: a LIMBIC MATARS Consortium Investigation

ABSTRACT Objective To investigate the association between sport type (collision, contact, non-contact) and subsequent injury risk following concussion in collegiate athletes. Materials and Methods This retrospective chart review of 248 collegiate athletes with diagnosed concussions (age: 20.0 ± 1.4 years; height: 179.6 ± 10.9 cm; mass: 79.0 ± 13.6 kg, 63% male) from NCAA athletic programs (n = 11) occurred between the 2015–2020 athletic seasons. Acute injuries that occurred within six months following concussion were evaluated. Subsequent injuries were grouped by lower extremity, upper extremity, trunk, or concussion. The independent variable was sport type: collision, contact, non-contact. A Cox proportional hazard model was used to assess the risk of subsequent injury between sport types. Results Approximately 28% (70/248) of athletes sustained a subsequent acute injury within six months post-concussion. Collision sport athletes had a significantly higher risk of sustaining any injury (HR: 0.41, p < 0.001, 95% CI: 0.28, 0.62), lower extremity (HR: 0.55, p = 0.04, 95% CI: 0.32, 0.97), and upper extremity (HR: 0.41, p = 0.01, 95% CI: 0.20, 0.81) injuries following concussion. No differences between sport types were observed for other injuries. Conclusion Collision sport athletes had a higher rate of any subsequent injury, lower, and upper extremity injuries following concussion. Future research should focus on sport-specific secondary injury prevention efforts.

Initial versus Subsequent Injury and Illness and Temporal Trends Among Professional Hockey Players.

Research is limited investigating injuries/illness incidence among National Hockey League (NHL) players. This study sought to establish injury/illness incidence, initial versus subsequent injury risk among NHL players, and determine temporal trends of injury and illness incidence. Variations in injury incidence by body region, and initial versus subsequent injury would be observed among positions. Retrospective cohort study. Publicly available data were utilized. NHL players 18 years or older between 2007-2008 to 2018-2019 were included. Injury and illness was stratified by position and body segment. Incidence rate (IR), and initial versus subsequent injury and illness risk ratios were calculated. Temporal trends were reported. Nine thousand, seven-hundred and thirty four injuries and illnesses were recorded. Centers had the highest overall IR at 15.14 per 1000 athlete game exposures (AGEs) (95%CI:15.12-15.15) and were 1.4 times more likely to sustain a subsequent injury compared to other positions. The groin/hip/thigh was the most commonly injured body region with an IR of 1.14 per 1000 AGEs (95%CI:1.06-1.21), followed by the head/neck (0.72 per 1000 AGEs, 95%CI:0.66-0.78). Combined injury and illness IR peaked in 2009-2010 season at 12.01 (95%CI: 11.22-12.79). The groin/hip/thigh demonstrated peak incidence during the 2007-2008 season (2.53, 95%CI:2.17-2.90); head/neck demonstrated a peak incidence in 2010-2011 season (Overall: 1.03, 95%CI:0.81-1.26). Injuries reported as 'lower body' increased over time. Positional differences were observed; centers demonstrated the highest overall IR, and subsequent injury risk. Injury by body region was similar to previous literature. Head/neck and concussion decreased over time supporting rule changes in body checking and visor wear. Clinicians should be aware that 'lower body' injuries increased over time; therefore, injuries to the groin/hip/thigh or knee are likely underreported. Level 3.

Anterior Cruciate Ligament Injury Does Not Increase the Risk for a Future Concussion: A Unidirectional Phenomenon.

Epidemiological studies have shown an increased risk of musculoskeletal injury after concussion. The purpose of this study was to determine whether the reverse relationship exists, specifically whether there is an increased risk of concussion after an anterior cruciate ligament (ACL) injury in a population-based cohort. Retrospective cohort. The Rochester Epidemiology Project was searched between 2000 and 2017 for International Classification of Diseases, 9th and 10th Revision codes relevant to the diagnosis and treatment of concussion and ACL tear. A total of 1294 unique patients with acute, isolated ACL tears and no previous history of concussion were identified. Medical records for cases were reviewed to confirm ACL tear diagnosis and to determine history of concussion after the ACL injury. Cases were matched by age, sex, and Rochester Epidemiology Project availability to patients without an ACL tear (1:3 match), resulting in 3882 controls. Medical records of matched control patients were reviewed to rule out history of ACL injury. The hazard ratio of concussion injury following an ACL injury was determined. Nine patients with an ACL injury suffered concussion up to 3years after the ACL injury. The rate of concussion was no different between ACL-injured cases (0.7%) compared with matched controls with no ACL injury (1.2%), which corresponded to a hazard ratio of 0.55 (95% confidence interval, 0.3-1.1; P = .10). Based on the current evidence, there does not appear to be a significant association between ACL injury and subsequent concussion, which suggests that a concussion uniquely affects the risk of future subsequent musculoskeletal injury.

Return-to-Play With R2Play: Protocol for Evaluating Cross-Site Feasibility, Face Validity, and Content Validity of a Multidomain Concussion Assessment Tool for Youth

Context: Clinical concussion assessments do not typically simulate the speed or complexity of sport. Performance changes arising from combined physical, cognitive, and sensory demands of sport may thus remain undetected during rehabilitation. We developed R2Play, a multidomain return-to-play assessment tool for youth with concussions. R2Play involves levels and conditions that vary in physical, cognitive, and sensory load to simulate the multidomain demands of sport. Objectives: To explore cross-site feasibility, face validity, and content validity of R2Play by integrating quantitative and qualitative data. Methods: Convergent mixed-methods feasibility study. Five sites will each recruit 5 clinicians (total nc = 25) and 10 youth sport participants (ages 10–25 y) with a history of concussion in the previous year (total ny = 50). Feasibility will be evaluated using quantitative criteria for acceptability, demand, implementation, practicality, and integration, and qualitative investigated data from content analysis of postassessment interviews with youth and clinician participants. Face validity will be investigated in postassessment interviews. Content validity will be established through (1) changes in performance metrics (time to completion, errors, and heart rate) across R2Play levels, (2) youth-perceived physical and cognitive exertion for each level, and (3) overall clinician perceptions determined through postassessment interviews. Qualitative and quantitative data will be merged through joint display to identify areas of convergence, divergence, and complementarity, and to establish meta-inferences about feasibility, face validity, and content validity. Discussion: This study aims to demonstrate the face and content validity of R2Play, and its feasibility for cross-site implementation. Findings will guide further iteration of R2Play and establish the foundation for a larger multicenter validation study to establish the psychometric properties of R2Play. This work represents an important first step toward the implementation of an ecologically valid multidomain assessment tool designed to support a safe and efficient return-to-play after concussion, ultimately reducing the risk of recurrent concussion and subsequent injury.

Integrative data analysis to identify persistent post-concussion deficits and subsequent musculoskeletal injury risk: project structure and methods

Concussions are a serious public health problem, with significant healthcare costs and risks. One of the most serious complications of concussions is an increased risk of subsequent musculoskeletal injuries (MSKI)....