Explosive blast has been extensively used as a tactical weapon in Operation Iraqi Freedom (OIF) and more recently in Operation Enduring Freedom(OEF). The polytraumatic nature of blast injuries is ...evidence of their effectiveness,and brain injury is a frequent and debilitating form of this trauma. In-theater clinical observations of brain-injured casualties have shown that edema, intracranial hemorrhage, and vasospasm are the most salient pathophysiological characteristics of blast injury to the brain. Unfortunately, little is known about exactly how an explosion produces these sequelae as well as others that are less well documented. Consequently, the principal objective of the current report is to present a swine model of explosive blast injury to the brain. This model was developed during Phase I of the DARPA (Defense Advanced Research Projects Agency) PREVENT (Preventing Violent Explosive Neurotrauma) blast research program. A second objective is to present data that illustrate the capabilities of this model to study the proximal biomechanical causes and the resulting pathophysiological, biochemical,neuropathological, and neurological consequences of explosive blast injury to the swine brain. In the concluding section of this article, the advantages and limitations of the model are considered, explosive and air-overpressure models are compared, and the physical properties of an explosion are identified that potentially contributed to the in-theater closed head injuries resulting from explosions of improvised explosive devices (IEDs).
Purpose
To identify football-specific factors associated with ACL injuries that can be targeted for sport-specific injury prevention.
Methods
A study-specific questionnaire was developed to study the ...characteristics of ACL injuries in football including intrinsic, extrinsic, and injury specific factors. The questionnaire was available at the Swedish national knee ligament registry’s website for the football players to voluntarily fill out. Data are presented on group level for all football players in total and for females and males separate to examine gender-specific differences. The results are based on answers collected over a 3-year period from 2875 football players, 1762 (61%) males and 1113 (39%) females.
Results
ACL were more frequently sustained during games 66% than during practices 25%. The injury mechanism was non-contact in 59% and contact in 41%. For the contact injuries during games, no action was taken by the referee in 63% of the situation and a red card was shown in 0.5%. The risk of ACL injury was highest early in the football game with 47% sustained during the first 30 min and 24% in the first 15 min. Players changing to a higher level of play 15% had a higher rate of ACL injuries than players changing to a lower level 8%. This difference was especially seen in female football players with 20% of ACL injuries being sustained by players going to a higher division compared to 7% for those going to a lower division. 15% of the male and 21% of the female ACL injuries occurred in teams with a coach change during the season. Knee control exercises to warm up was used by 31% of the female players and 16% of the males. 40% of the players reported that they did not plan on returning to football.
Conclusion
Neuromuscular training programs have proven to reduce ACL injuries, but greater adherence to these remains a challenge as only 1 in 5 of the ACL-injured football players report using them. Teams changing coach and players going to a higher division appear to have an increased risk of ACL injury warranting attention and further investigations.
Level of evidence
IV.
Reactive oxygen species (ROS) contribute to tissue damage and remodelling mediated by the inflammatory response after injury. Here we show that ROS, which promote axonal dieback and degeneration ...after injury, are also required for axonal regeneration and functional recovery after spinal injury. We find that ROS production in the injured sciatic nerve and dorsal root ganglia requires CX3CR1-dependent recruitment of inflammatory cells. Next, exosomes containing functional NADPH oxidase 2 complexes are released from macrophages and incorporated into injured axons via endocytosis. Once in axonal endosomes, active NOX2 is retrogradely transported to the cell body through an importin-β1-dynein-dependent mechanism. Endosomal NOX2 oxidizes PTEN, which leads to its inactivation, thus stimulating PI3K-phosporylated (p-)Akt signalling and regenerative outgrowth. Challenging the view that ROS are exclusively involved in nerve degeneration, we propose a previously unrecognized role of ROS in mammalian axonal regeneration through a NOX2-PI3K-p-Akt signalling pathway.
Prevention of Injuries among Male Soccer Players Engebretsen, Anders H.; Myklebust, Grethe; Holme, Ingar ...
The American journal of sports medicine,
06/2008, Volume:
36, Issue:
6
Journal Article
Peer reviewed
Open access
Background
This study was conducted to investigate whether the most common injuries in soccer could be prevented, and to determine if a simple questionnaire could identify players at increased risk.
...Hypothesis
Introduction of targeted exercise programs to male soccer players with a history of previous injury or reduced function in the ankle, knee, hamstring, or groin will prevent injuries.
Study Design
Randomized controlled trial; Level of evidence, 2.
Methods
A total of 508 players representing 31 teams were included in the study. A questionnaire indicating previous injury and/or reduced function as inclusion criteria was used to divide the players into high-risk (HR) (76%) and low-risk (LR) groups. The HR players were randomized individually into an HR intervention group or HR control group.
Results
A total of 505 injuries were reported, sustained by 56% of the players. The total injury incidence was a mean of 3.2 (95% confidence interval CI, 2.5–3.9) in the LR control group, 5.3 (95% Cl, 4.6–6.0) in the HR control group (P = .0001 vs the LR control group), and 4.9 (95% Cl, 4.3–5.6) in the HR intervention group (P = .50 vs the HR control group). For the main outcome measure, the sum of injuries to the ankle, knee, hamstring, and groin, there was also a significantly lower injury risk in the LR control group compared with the 2 other groups, but no difference between the HR intervention group and the HR control group. Compliance with the training programs in the HR intervention group was poor, with only 27.5% in the ankle group, 29.2% in the knee group, 21.1% in the hamstring group, and 19.4% in the groin defined as having carried out the minimum recommended training volume.
Conclusion
The players with a significantly increased risk of injury were able to be identified through the use of a questionnaire, but player compliance with the training programs prescribed was low and any effect of the intervention on injury risk could not be detected.
Background:
Prospective studies have reported that abnormal movement patterns at the trunk, hip, and knee are associated with noncontact anterior cruciate ligament (ACL) injuries. Impaired hip ...strength may underlie these abnormal movement patterns, suggesting that diminished hip strength may increase the risk of noncontact ACL injury.
Purpose:
To determine whether baseline hip strength predicts future noncontact ACL injury in athletes.
Study Design:
Case-control study; Level of evidence, 3.
Methods:
Before the start of the competitive season, isometric hip strength (external rotation and abduction) was measured bilaterally by use of a handheld dynamometer in 501 competitive athletes (138 female and 363 male athletes) participating in various sports. During the sport season, ACL injury status was recorded, and injured athletes were further classified based on the mechanism of injury (noncontact vs contact). After the season, logistic regression was used to determine whether baseline hip strength predicted future noncontact ACL injury. Receiver operating characteristic (ROC) curves were constructed independently for each strength measure to determine the clinical cutoff value between a high-risk and low-risk outcome.
Results:
A total of 15 noncontact ACL injuries were confirmed (6 females, 9 males), for an overall annual incidence of 3.0% (2.5% for males, 4.3% for females). Baseline hip strength measures (external rotation and abduction) were significantly lower in injured athletes compared with noninjured athletes (P = .003 and P < .001, respectively). Separate logistic regression models indicated that impaired hip strength increased future injury risk (external rotation: odds ratio OR = 1.23 95% CI, 1.08-1.39, P = .001; abduction: OR = 1.12 95% CI, 1.05-1.20, P = .001). Clinical cutoffs to define high risk were established as external rotation strength ≤20.3% BW (percentage of body weight) or abduction strength ≤35.4% BW.
Conclusion:
Measures of preseason isometric hip abduction and external rotation strength independently predicted future noncontact ACL injury status in competitive athletes. The study data suggest that screening procedures to assess ACL injury risk should include an assessment of isometric hip abduction and/or external rotation strength.
Background:
Previous research has noted sex-based differences in anterior cruciate ligament (ACL) injury rates in young athletes, while little is known about medial collateral ligament (MCL) and ...meniscal injury rates in this population. The objective of this study was to compare injury rates for traumatic knee injuries (ie, ACL, MCL, and meniscal injuries) in collegiate and high school (HS) varsity student-athletes across multiple sports.
Hypothesis:
Knee injury rates vary by sex and across different sports and levels of competition.
Study Design:
Descriptive epidemiology study.
Methods:
Injury and athlete-exposure data were utilized from the National Athletic Treatment, Injury and Outcomes Network (NATION) and National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) during the 2009-2010 to 2013-2014 academic years. Analyses focused on ACL, MCL, and meniscal injuries. Injury rates and injury rate ratios (IRRs) with 95% CIs were calculated for basketball, ice hockey, lacrosse, soccer, and baseball/softball.
Results:
The ACL injury rate was higher for female than male athletes at the collegiate (IRR, 2.49; 95% CI, 1.81-3.41) and HS (IRR, 2.30; 95% CI, 1.67-3.18) levels. At the collegiate level, the highest ACL IRR comparing female to male athletes was reported in softball/baseball (IRR, 6.61; 95% CI, 1.48-29.55). At the HS level, the highest ACL IRR was reported in basketball (IRR, 3.68; 95% CI, 1.91-7.10). The MCL injury rate was higher for female than male athletes at the HS level (IRR, 2.11; 95% CI, 1.25-3.56) but lower for female than male athletes at the collegiate level (IRR, 0.73; 95% CI, 0.59-0.92). The meniscal injury rate was lower for female than male athletes at the HS level (IRR, 0.47; 95% CI, 0.31-0.71), while no differences by sex were seen at the collegiate level (IRR, 1.35; 95% CI, 0.90-2.02).
Conclusion:
Knee injury rates varied by sex across 5 different sports in the HS and collegiate settings. Female athletes sustained ACL injuries at a higher rate than male athletes at both the HS and collegiate levels in these 5 sports; however, there was not a distinct sex disparity in MCL and meniscal injuries. Future studies should examine the rates of concomitant and recurrent injuries to inform injury prevention and rehabilitation programs.
Little is known about the rate and pattern of injuries in international volleyball competition.
To describe the risk and pattern of injuries among world-class players based on data from the The ...International Volleyball Federation (FIVB) Injury Surveillance System (ISS) (junior and senior, male and female).
The FIVB ISS is based on prospective registration of injuries by team medical staff during all major FIVB tournaments (World Championships, World Cup, World Grand Prix, World League, Olympic Games). This paper is based on 4-year data (September 2010 to November 2014) obtained through the FIVB ISS during 32 major FIVB events (23 senior and 9 junior).
The incidence of time-loss injuries during match play was 3.8/1000 player hours (95% CI 3.0 to 4.5); this was greater for senior players than for junior players (relative risk: 2.04, 1.29 to 3.21), while there was no difference between males and females (1.04, 0.70 to 1.55). Across all age and sex groups, the ankle was the most commonly injured body part (25.9%), followed by the knee (15.2%), fingers/thumb (10.7%) and lower back (8.9%). Injury incidence was greater for centre players and lower for liberos than for other player functions; injury patterns also differed between player functions.
Volleyball is a very safe sport, even at the highest levels of play. Preventive measures should focus on acute ankle and finger sprains, and overuse injuries in the knee, lower back and shoulder.
Traumatic brain injury (TBI) and blunt thoracic aortic injury (BTAI) are the top two leading causes of death after blunt force trauma. Patients presenting with concomitant BTAI and TBI pose a ...specific challenge with respect to management strategy, because the optimal hemodynamic parameters are conflicting between the two pathologies. Early thoracic endovascular aortic repair (TEVAR) is often performed, even for minimal aortic injuries, to allow for the higher blood pressure parameters required for TBI management. However, the optimal timing of TEVAR for the treatment of BTAI in patients with concomitant TBI remains an active matter of controversy.
The Aortic Trauma Foundation international prospective multicenter registry was used to identify all patients who had undergone TEVAR for BTAI in the setting of TBI from 2015 to 2020. The primary outcomes included delayed ischemic or hemorrhagic stroke, in-hospital mortality, and aortic-related mortality. The outcomes were examined among patients who had undergone TEVAR at emergent (<6 vs ≥6 hours) or urgent (<24 vs ≥24 hours) intervals.
A total of 100 patients (median age, 43 years; 79% men; median injury severity score, 41) with BTAI (Society for Vascular Surgery BTAI grade 1, 3%; grade 2, 10%; grade 3, 78%; grade 4, 9%) and concomitant TBI who had undergone TEVAR were identified. Emergent repair was performed for 51 patients (51%). Comparing emergent repair (<6 hours) to urgent repair (≥6 hours), no difference was found in delayed cerebral ischemic events (2.0% vs 4.1%; P = .614), in-hospital mortality (15.7% vs 22.4%; P = .389), or aortic-related mortality (2.0% vs 2.0%; P = .996) and no patient had experienced delayed hemorrhagic stroke. Likewise, repairs conducted in an urgent (<24 hours) setting showed no differences compared with those completed in an emergent (≥24 hours) setting regarding delayed ischemic stroke (2.6% vs 4.3%; P = .548), in-hospital mortality (18.2% vs 21.7%; P = .764), or aortic-related mortality (1.3% vs 4.3%; P = .654), and no patient had experienced delayed hemorrhagic stroke.
In contrast to prior retrospective efforts, results from the Aortic Trauma Foundation international prospective multicenter registry have demonstrated that neither emergent nor urgent TEVAR for patients with concomitant BTAI and TBI was associated with delayed stroke, in-hospital mortality, or aortic-related mortality. In these patients, the timing of TEVAR did not have an effect on the outcomes. Therefore, the decision to intervene should be guided by individual patient factors rather than surgical timing.
The need for improved methods of hemorrhage control and resuscitation has resulted in a reappraisal of resuscitative endovascular balloon occlusion of the aorta (REBOA). However, there is a paucity ...of data regarding the use of REBOA on a multi-institutional level in the United States.
To evaluate the outcomes in trauma patients after REBOA placement.
A case-control retrospective analysis was performed of the 2015-2016 American College of Surgeons Trauma Quality Improvement Program data set, a national multi-institutional database of trauma patients in the United States. A total of 593 818 adult trauma patients (aged ≥18 years) were analyzed and 420 patients were matched and included in the study; patients who were dead on arrival or were transferred from other facilities were excluded. Trauma patients who underwent REBOA placement in the ED were identified and matched with a similar cohort of patients (the no-REBOA group). Both groups were matched in a 1:2 ratio using propensity score matching for demographics, vital signs, mechanism of injury, injury severity score, head abbreviated injury scale score, each body region abbreviated injury scale score, pelvic fractures, lower extremity vascular injuries and fractures, and number and grades of intra-abdominal solid organ injuries.
Outcome measures were the rates of complications and mortality.
Of 593 818 trauma patients, 420 patients (the REBOA group, 140 patients; 36 women and 104 men; mean SD age, 44 20 years; the no-REBOA group, 280 patients; 77 women and 203 men; mean SD age, 43 19 years) were matched and included in the analysis. Among the REBOA group, median injury severity score was 29 (interquartile range IQR, 18-38) and 129 patients (92.1%) had a blunt mechanism of injury. There was no significant difference between groups in median 4-hour blood transfusion (REBOA: packed red blood cells, 6 U IQR, 3-8 U; platelets, 4 U IQR, 3-9 U, and plasma, 3 U IQR, 2-5 U; and no-REBOA: packed red blood cells, 7 U IQR, 3-9 U; platelets, 4 U IQR, 3-8 U, and plasma, 3 U IQR, 2-6 U) or 24-hour blood transfusion (REBOA: packed red blood cells, 9 U IQR, 5-20 U; platelets, 7 U IQR, 3-13 U, and plasma, 9 U IQR, 6-20 U; and no-REBOA: packed red blood cells, 10 U IQR, 4-21 U; platelets, 8 U IQR, 3-12 U, and plasma, 10 U IQR, 7-20 U), median hospital length of stay (REBOA, 8 days IQR, 1-20 days; and no-REBOA, 10 days IQR, 5-22 days), or median intensive care unit length of stay (REBOA, 5 days IQR, 2-14 days; and no-REBOA, 6 days IQR, 3-15 days). The mortality rate was higher in the REBOA group as compared with the no-REBOA group (50 35.7% vs 53 18.9%; P = .01). Patients who underwent REBOA placement were also more likely to develop acute kidney injury (15 10.7% vs 9 3.2%; P = .02) and more likely to undergo lower extremity amputation (5 3.6% vs 2 0.7%; P = .04).
Placement of REBOA in severely injured trauma patients was associated with a higher mortality rate compared with a similar cohort of patients with no placement of REBOA. Patients in the REBOA group also had higher rates of acute kidney injury and lower leg amputations. There is a need for a concerted effort to clearly define when and in which patient population REBOA has benefit.
Traumatic brain injury (TBI) is a major cause of acquired disability globally, and effective treatment methods are scarce. Lately, there has been increasing recognition of the devastating impact of ...TBI resulting from sports and other recreational activities, ranging from primarily sport‐related concussions (SRC) but also more severe brain injuries requiring hospitalization. There are currently no established treatments for the underlying pathophysiology in TBI and while neuro‐rehabilitation efforts are promising, there are currently is a lack of consensus regarding rehabilitation following TBI of any severity. In this narrative review, we highlight short‐ and long‐term consequences of SRCs, and how the sideline management of these patients should be performed. We also cover the basic concepts of neuro‐critical care management for more severely brain‐injured patients with a focus on brain oedema and the necessity of improving intracranial conditions in terms of substrate delivery in order to facilitate recovery and improve outcome. Further, following the acute phase, promising new approaches to rehabilitation are covered for both patients with severe TBI and athletes suffering from SRC. These highlight the need for co‐ordinated interdisciplinary rehabilitation, with a special focus on cognition, in order to promote recovery after TBI.
Content List ‐ Read more articles from the symposium: “Head Trauma in Sports and Risk for Dementia”.
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