Background:
Infolding and retraction of an avulsed deltoid complex after ankle fracture can be a source of persistent increased medial clear space, malreduction, and postoperative pain and medial ...instability. The purpose of this descriptive case series was to analyze the preliminary outcomes of acute superficial deltoid complex avulsion repair during ankle fracture fixation in a cohort of National Football League (NFL) players. We found that there is often complete avulsion of the superficial deltoid complex off the proximal aspect of the medial malleolus during high-energy ankle fractures in athletes.
Methods:
Between 2004 and 2014, the cases of 14 NFL players who underwent ankle fracture fixation with open deltoid complex repair were reviewed. Patients with chronic deltoid ligament injuries or ankle fractures more than 2 months old were excluded. Average age for all patients was 25 years and body mass index 34.4. Player positions included 1 wide receiver, 1 tight end, 1 safety, 1 running back, 1 linebacker, and 9 offensive linemen. Average time from injury to surgery was 7.5 days. Surgical treatment for all patients consisted of ankle arthroscopy and debridement, followed by fibula fixation with plate and screws, syndesmotic fixation with suture-button devices, and open deltoid complex repair with suture anchors. Patient demographics were recorded with position played, time from injury to surgery, games played before and after surgery, ability to return to play, and postoperative complications. Return to play was defined as the ability to successfully participate in at least 1 full regular-season NFL game after surgery.
Results:
All NFL players were able to return to running and cutting maneuvers by 6 months after surgery. There were no significant differences in playing experience before surgery versus after surgery. Average playing experience before surgery was 3.3 seasons, 39 games played, and 22 games started. Average playing experience after surgery was 1.6 seasons, 16 games played, and 15 games started. Return to play was 86% for all players. There were no intraoperative or postoperative complications noted, and no players had clinical evidence of medial pain or instability at final follow-up with radiographic maintenance of anatomic mortise alignment.
Conclusion:
Superficial deltoid complex avulsion during high-energy ankle fractures in athletes is a distinct injury pattern that should be recognized and may benefit from primary open repair. The majority of NFL players treated surgically for this injury pattern are able to return to play after surgery with no reported complications or persistent medial ankle pain or instability.
Level of Evidence:
Level IV, retrospective case series.
This paper presents an explanation of why a spinning football rotates so that the spin axis remains nearly aligned with the velocity vector, and approximately parallel to the tangent to the ...trajectory. The paper derives the values of the characteristic frequencies associated with the football’s precession and nutation. The paper presents a graphical way of visualizing how the motions associated with these frequencies result in the observed “wobble” of the football. A solution for the linearized dynamics shows that there is a minimum amount of spin required for the motion to be stable and for the football not to tumble. This paper notes the similarity of this problem to that of spun projectiles. The results show that the tendency of a football to align itself with and rotate with the velocity vector is associated with an equilibrium condition with a non-zero aerodynamic torque. The torque is precisely the value required for the football to rotate at the same angular rate as the velocity vector. An implication of this is that a release with the football spin axis and velocity vector aligned (zero aerodynamic torque) is not the condition that results in minimum motion after release. Minimum “wobble” occurs when the ball is released with its symmetry axis slightly to the right or left of the velocity vector, depending on the direction of the spin. There are additional forces and moments acting on the football that affect its trajectory and its stability, but it is not necessary to consider these to explain the tendency of the ball to align with the velocity vector and to ”wobble.” The results of this paper are equally applicable to the spiral pass in American football and the screw kick in rugby.
INTRODUCTION Over 10,000 sport-related concussions (SRCs) are reported to the National Collegiate Athletic Association (NCAA) annually. The NCAA’s SRC management policy requires schools to have a ...plan in place for diagnosis and return to play. However, it does not mandate protocols for these tasks, or any qualifications/certifications necessary to complete them. METHODS A 30-question multiple choice survey, including 5 clinical vignette questions, was distributed via email to 1430 providers at 82 institutions. 156 of 206 responses were included based on a completion threshold of 85%. Data was analyzed using independent T and ANOVA tests. RESULTS Providers working with female athletes performed better on clinical vignette questions (CVQs) than those working with both males and females (P = .042). Providers who worked with football performed worse on CVQs than those who did not (P = .033). 89% of responding schools (n = 69) refer to primary care (team) physicians (PCPs) for SRC diagnosis/management. There was no difference in knowledge-base of SRC diagnosis/management between Certified Athletic Trainers and PCPs (P = .805). Of those who agreed that they were adequately trained to diagnose/manage SRCs, the average CVQ score was 56%. Neither training instructor nor format were related to CVQ score, but there was a trend toward experience diagnosing concussions being related to performance. CONCLUSION Referring concussed student-athletes to team PCPs for evaluation and clearance does not necessarily improve care for the athlete. Providers who work with football players may tend to focus their attention there and lose their ability to recognize concussion symptoms in non-football contexts. Experience diagnosing concussions seems to be related to provider readiness. Case-based concussion education modules may increase providers' exposure to concussion presentations, and thus may improve provider knowledge-base and readiness.
IMPORTANCE: Studies of the longevity of professional American football players have demonstrated lower mortality relative to the general population but they may have been susceptible to selection ...bias. OBJECTIVE: To examine the association between career participation in professional American football and mortality risk in retirement. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study involving 3812 retired US National Football League (NFL) players who debuted in the NFL between 1982 and 1992, including regular NFL players (n = 2933) and NFL “replacement players” (n = 879) who were temporarily hired to play during a 3-game league-wide player strike in 1987. Follow-up ended on December 31, 2016. EXPOSURES: NFL participation as a career player or as a replacement player. MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality by December 31, 2016. Cox proportional hazards models were estimated to compare the observed number of years from age 22 years until death (or censoring), adjusted for birth year, body mass index, height, and position played. Information on player death and cause of death was ascertained from a search of the National Death Index and web-based sources. RESULTS: Of the 3812 men included in this study (mean SD age at first NFL activity, 23.4 1.5 years), there were 2933 career NFL players (median NFL tenure, 5 seasons interquartile range {IQR}, 2-8; median follow-up, 30 years IQR, 27-33) and 879 replacement players (median NFL tenure, 1 season IQR, 1-1; median follow-up, 31 years IQR, 30-33). At the end of follow-up, 144 NFL players (4.9%) and 37 replacement players (4.2%) were deceased (adjusted absolute risk difference, 1.0% 95% CI, −0.7% to 2.7%; P = .25). The adjusted mortality hazard ratio for NFL players relative to replacements was 1.38 (95% CI, 0.95 to 1.99; P = .09). Among career NFL players, the most common causes of death were cardiometabolic disease (n = 51; 35.4%), transportation injuries (n = 20; 13.9%), unintentional injuries (n = 15; 10.4%), and neoplasms (n = 15; 10.4%). Among NFL replacement players, the leading causes of death were cardiometabolic diseases (n = 19; 51.4%), self-harm and interpersonal violence (n = 5; 13.5%), and neoplasms (n = 4; 10.8%). CONCLUSIONS AND RELEVANCE: Among NFL football players who began their careers between 1982 and 1992, career participation in the NFL, compared with limited NFL exposure obtained primarily as an NFL replacement player during a league-wide strike, was not associated with a statistically significant difference in long-term all-cause mortality. Given the small number of events, analysis of longer periods of follow-up may be informative.
ObjectiveTo estimate the number of retirements following concussion among American football programs of the NCAA autonomy five conferences (A5) in 2018.DesignSurvey. Questions pertaining to ...retirement following concussion at each program during the 2018 football year (winter conditioning – bowl game) were analyzed.SettingA football safety meeting sponsored by the National Football League and the National Collegiate Athletic Association (NCAA) was held June 2019 in Indianapolis, Indiana, USA.ParticipantsThe head athletic trainer and team physicians from A5 universities.Main ResultsMedical staff from 45 (69.2%) of 65 A5 football programs completed the retirement portion of the survey. Participating universities reported 25 retirements following concussions in the 2018 football year with 44% of universities having at least one football athlete retire. The extrapolated rate of retirements following concussion among all A5 football programs was 36.1, which equates to a rate of 0.55 retirements per university during 2018. Of all football related concussions in 2018, 3.9% (36.1/937) were followed by retirement from football.ConclusionsThis study, based on information directly reported by sports health providers at A5 institutions, estimates a 3.9% retirement rate following concussion specifically for NCAA A5 football programs, which has not been previously reported. It may provide a benchmark for comparison and allow assessment of the effectiveness of future safety and counseling measures implemented after 2018.
ObjectiveTo investigate severity and burden of head injuries in women’s football.DesignProspective cohort study.SettingClubs in premier division of women’s football in Finland.Participants237 players ...from 10 clubs were followed for injuries and team exposure during seasons 2020–2021 (66 weeks in total).Interventions (or Assessment of Risk Factors)Injuries were registered using weekly Oslo Sports Trauma Research Center Health Questionnaire (OSTRC-H2). Players reported injuries via a mobile application. Team-based training and match exposure was collected from coaches each week. Injury definition was based on all physical complaints. Substantial injuries were defined as injuries leading to moderate or severe modifications in performance/participation, or time loss. In addition, number of total days missed was registered.Outcome MeasuresNumber and self-reported severity of head/face injuries.Main ResultsAltogether 13 head/face injuries were reported by 11 players (0.2 injuries/1000 exposure hours). Nine head/face injuries were reported as concussions, three were undefined contusions. Nearly all (12 out of 13) injuries were substantial injuries. Only one injury caused no time loss from full participation. Median of total days missed was 4 days (range 0–19). However, players reported suffering from the consequences of a head injury on average in two consecutive weekly health reports (median 1; range 1–7).ConclusionsHead injuries often lead to several days of modified participation and performance deficits in female football players. Many players report being unable to fully participate in sport even after two weeks of head injury.
ObjectiveTo assess awareness and sources of concussion information in amateur football players, as well as understand trends in concussion management in this population.DesignRetrospective, ...cross-sectional study.SettingOnline questionnaire of recreational football and rugby players in the United Kingdom.ParticipantsA total of 944 responses were returned. Of these, 102 recorded ‘football/soccer’ as their most played sport. Three of these were excluded on the basis of age. The remaining respondents (n=99) were included in the data analysis of this study. Respondents were categorized by age group: 19–29 years old (n=31), 30–39 years old (n=38), and 40+ years old (n=30).Outcome MeasuresAwareness of concussion guidelines, management of concussion, sources of concussion information.Main Results51.5% of participants were unaware of any concussion guidelines. Only 38.4% of respondents were aware of the FA Concussion Guidelines. In our survey, of those with previously diagnosed or suspected concussions, most (60.9%) did not seek professional medical care. Furthermore, after suspecting a concussion, 64.3% did not stop playing or training, citing ‘Did not want to stop playing’ as the most common reason why (72.2%). 91.9% agreed that more concussion information is needed at the recreational level. The preferred source of this information differed significantly by age group(x2(2) = 10.30, p<0.01).ConclusionsConcussion information is poorly disseminated amongst the amateur playing population. There is a trend towards self-management, despite insufficient knowledge for this purpose. Social media was found to be a preferred target to increase awareness of current concussion guidelines.
ObjectiveTo describe the domains and assessment tools utilized during baseline concussion testing among the American football programs of the NCAA Division 1 Autonomy Five Conferences (A5) during ...2018. The frequency of re-baseline testing after concussion was also examined.DesignSurvey.SettingA football safety meeting sponsored by the NFL and the NCAA was held June 2019 in Indianapolis, Indiana, USA.ParticipantsThe head athletic trainer and team physicians from 46 of 65 (70.7%) A5 universities.Interventions (or Assessment of Risk Factors)Attendees from each institution were surveyed regarding their institution’s baseline and re-baseline concussion testing practices in 2018. Each institution provided one response.Outcome MeasuresDescription of baseline and re-baseline concussion testing practices at NCAA A5 American football programs during 2018.Main ResultsParticipating institutions reported measurement of postural stability (98%), computerized neurocognitive functioning (87%), and vestibular and/or ocular functioning (61%) during routine baseline concussion testing. A5 institutions measure postural stability using the Balance Error Scoring System (BESS, 35%), device-based measurement tools (29%), modified BESS (27%), and timed tandem gait (7%). Computerized neurocognitive tests include ImPACT (64%), C3 Logix (17%), Axon Sports/CogState (7%), and CNS Vital Signs (5%). Measurement of vestibular and/or ocular functioning consists of eye tracking devices (33%), Vestibular-Ocular Motor Screening (VOMS, 31%), King-Devick Test (28%), and convergence alone (3%). Twenty-six percent of programs specifically re-baselined football athletes after concussion. Of the schools that do not re-baseline, they most commonly baseline all football athletes only once upon matriculation (39%), annually (17%), or and bi-annually (13%).ConclusionsFor the 2018 football year, most A5 programs assessed postural stability and computerized neurocognitive functioning in their routine baseline concussion testing programs but there was variability in the tools utilized. The frequency of specified re-baseline testing of athletes after concussion was 26%.
ObjectiveThis study investigates the days of absence after concussion in the two highest professional football (soccer) leagues in Germany between 2014 and 2020.DesignRetrospective analysis of all ...concussions registered by clubs or physicians at the trauma insurance (VBG) as part of mandatory occupational accident reporting.SettingMen´s German 1st and 2nd Bundesliga.Participants152 players with diagnosed concussion (mean age 25.1 years ± 4.0 standard deviation).Interventions (or Assessment of Risk Factors)Inter-season and inter-league comparisons were calculated by Kruskal-Wallis (KW) and unpaired samples t-tests.Outcome MeasuresPrevalence, match incidence rates and days of absence.Main Results126 of 172 (73.3%) reported concussions during 138.000 hours of match play result in a match incidence of 0.91 per 1.000 match hours. Concussion prevalence was 3.0% (range 2.5–4.0) per player per season (median 26.5 concussions per season, range 24–32). Mean time loss in days per concussion was significantly longer in the 1st compared to the 2nd Bundesliga (mean ± standard deviation: 7.29 ± 5.99 vs. 5.00 ± 4.46, p < 0.05). Absence time in the 1st Bundesliga was significantly longer in season 2019/20 (9.5 ± 4.8, median=8) compared to 2014/15 (3.89 ± 3.95, median=3) and 2015/16 (3.92 ± 4.42, median=3) (p<0.05), but there were no significant changes over time in the 2nd Bundesliga (2014/15: 4.29 ± 3.12, median=4 vs. 2019/20: 5.54 ± 6.27, median=2).ConclusionsAbsence time after concussion differs significantly between professional football (soccer) leagues in Germany. Concussion policies may have influenced adherence to concussion protocols in the 1st Bundesliga.
ObjectiveTo determine whether helmet dimensions worn by youth football players predict head impact biomechanics.DesignProspective cohort study.SettingLaboratory and on-field.ParticipantsTwenty-seven ...youth tackle football players (males=100%, age=12.2±0.4yrs, height=161.5±9.7m, mass=55.5±15.2kg) participated in this study.Outcome MeasuresPreseason helmet dimensions of total helmet mass, helmet circumference, facemask mass, and facemask length served as the independent variables. During the season, participants wore Triax SIM-G accelerometers that captured peak linear acceleration (PLA;g), rotational velocity (PRV; rad/s), and total number of impacts that served as the dependent variables (α=0.05).Main ResultsA total of 2,800 head impacts were recorded from the season. Each 1% rise in total helmet mass relative to body mass corresponded to 2.2 more impacts (R 2=0.356, P=0.022) sustained and 4.10rad/s higher PRV (R 2=0.150, P=0.028) on average per impact. Each 1% rise in facemask mass relative to body mass corresponded to 3.6 more head impacts (R 2=0.244, P=0.006) sustained and 3.22rad/s higher PRV (R 2=0.133, P=0.023) on average per impact. Each additional 1cm in facemask length corresponded with 4.0 more head impacts (R 2=0.178, P=0.018) sustained and 1.98rad/s higher PRV (R 2=0.153, P=0.032) on average per impact. Each additional 1cm in helmet circumference corresponded with 1.9rad/s higher PRV (P=0.018) on average per impact.ConclusionsHelmets that were heavier relative to the body mass, had heavier and longer facemasks, and greater in helmet circumference were associated with more frequent and severe head impacts. Results from this study may be used to inform leagues and helmet manufacturers to improve sport safety and mitigate head impacts.
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