The Impact of the COVID-19 Pandemic on the Most Common Diagnoses in Pediatric Surgery: Abdominal Pain, Acute Scrotum, Upper and Lower Extremity Injuries—Tertiary Center Experience

Objectives: The National Football League (NFL) has been under growing scrutiny from the public due to the apparent rise in concussions and head injuries and the subsequent deleterious effects. In efforts to address these concerns, the NFL implemented a new “Helmet-lowering” rule prior to the 2018-2019 season. This rule is defined as “a foul if a player lowers his head to initiate and make contact with his helmet against an opponent.” The purpose of this paper was to compare incidence of injuries in NFL players prior to and after implementation of this new rule. Methods: NFL injury data was retrospectively reviewed from public league records for all players in regular season games played from the 2017 and 2018 NFL seasons. An injury was defined as any player listed on a team’s injury report that was not previously documented on the team’s report one week preceding the index injury. Injury rates were reported as the number of injuries per 1000 athletic exposures (AE’s). Athletic exposures were defined as equal to the sum of the total number of NFL regular-season games played. Relative risk (with 95% CI) was calculated by using the number of injuries per 1000 athletic exposures for the season before and after the new rule implementation. Risk reduction was then calculated for the overall injuries, upper/lower extremity and head injuries. Results: Over the 2 seasons there were a total of 2,774 injuries identified. After rule implementation at the beginning of the 2018 season, there was an overall relative risk (RR) of 0.91 for injury (95% CI 0.88 to 0.95, p<0.0001), with an injury risk reduction of 8.73%. Upper extremity injuries had a RR of 0.76 (95% CI 0.65 to 0.87, p=0.0005) and a risk reduction of 24.10%. Lower extremity injuries had a RR of 0.91 (95% CI 0.87 to 0.96, p=0.0005) with a risk reduction of 8.63%. In concussions and head injuries there was an overall RR of 0.55 for injury (95% CI 0.44 to 0.69, p<0.0001), with an injury risk reduction of 45.10%. Wide receivers and linebackers were most commonly injured players on offense and defense, respectively. Conclusion: Implementation of the new Helmet-Lowering rule seems to have played a role in significantly decreasing the NFL athlete’s risk of injury across all measures, most notably in concussion and head injuries.

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Judgment and Approach for Management of Severe Lower Extremity Injuries

Clinics in Plastic Surgery ◽

10.1016/s0094-1298(20)30851-8 ◽

1991 ◽

Vol 18 (3) ◽

pp. 525-543 ◽

Cited By ~ 2

Author(s):

Robert L. Walton ◽

Douglas M. Rothkopf

Keyword(s):

Lower Extremity ◽

Lower Extremity Injuries ◽

Extremity Injuries

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Concussion in National Football League Athletes Is Not Associated With Increased Risk of Acute, Noncontact Lower Extremity Musculoskeletal Injury

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211003491 ◽

2021 ◽

Vol 9 (5) ◽

pp. 232596712110034

Author(s):

Toufic R. Jildeh ◽

Fabien Meta ◽

Jacob Young ◽

Brendan Page ◽

Kelechi R. Okoroha

Keyword(s):

Lower Extremity ◽

National Football League ◽

Field Performance ◽

Return To Play ◽

Lower Extremity Injury ◽

Extremity Injury ◽

Lower Extremity Injuries ◽

Increased Risk ◽

Extremity Injuries ◽

And Control

Background: Impaired neuromuscular function after concussion has recently been linked to increased risk of lower extremity injuries in athletes. Purpose: To determine if National Football League (NFL) athletes have an increased risk of sustaining an acute, noncontact lower extremity injury in the 90-day period after return to play (RTP) and whether on-field performance differs pre- and postconcussion. Study Design: Cohort study, Level of evidence, 3. Methods: NFL concussions in offensive players from the 2012-2013 to the 2016-2017 seasons were studied. Age, position, injury location/type, RTP, and athlete factors were noted. A 90-day RTP postconcussive period was analyzed for lower extremity injuries. Concussion and injury data were obtained from publicly available sources. Nonconcussed, offensive skill position NFL athletes from the same period were used as a control cohort, with the 2014 season as the reference season. Power rating performance metrics were calculated for ±1, ±2, and ±3 seasons pre- and postconcussion. Conditional logistic regression was used to determine associations between concussion and lower extremity injury as well as the relationship of concussions to on-field performance. Results: In total, 116 concussions were recorded in 108 NFL athletes during the study period. There was no statistically significant difference in the incidence of an acute, noncontact lower extremity injury between concussed and control athletes (8.5% vs 12.8%; P = .143), which correlates with an odds ratio of 0.573 (95% CI, 0.270-1.217). Days (66.4 ± 81.9 days vs 45.1 ± 69.2 days; P = .423) and games missed (3.67 ± 3.0 vs 2.9 ± 2.7 games; P = .470) were similar in concussed athletes and control athletes after a lower extremity injury. No significant changes in power ratings were noted in concussed athletes in the acute period (±1 season to injury) when comparing pre- and postconcussion. Conclusion: Concussed, NFL offensive athletes did not demonstrate increased odds of acute, noncontact, lower extremity injury in a 90-day RTP period when compared with nonconcussed controls. Immediate on-field performance of skill position players did not appear to be affected by concussion.

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EFFECTIVENESS OF PRE-SEASON PHYSICAL PERFORMANCE TESTS IN IDENTIFYING IN-SEASON LOWER EXTREMITY INJURIES IN ADOLESCENT GYMNASTS

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00141 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0014

Author(s):

Danielle A Farzanegan ◽

Emily Francione ◽

Nicole Melfi

Keyword(s):

Lower Extremity ◽

Physical Performance ◽

Performance Tests ◽

Kinetic Chain ◽

Chi Square ◽

Balance Test ◽

Lower Extremity Injuries ◽

Common Location ◽

Acute Injuries ◽

Extremity Injuries

Background: Artistic competitive gymnastics results in a wide, unique spectrum of injuries. Due to the high number of injuries and the current lack of research related to pre-competitive testing in adolescent gymnasts, it is crucial to find a method to predict the likelihood of an athlete sustaining an in-season injury. Purpose: The purpose of this study was to 1) describe the frequency and type of pre-season and in-season injuries, 2) determine if there were differences in physical performance tests between those who had a lower extremity (LE) injury in-season and those who did not, and 3) determine if there were differences in age, level, sex, BMI, sport modifications, previous injury, and current injury between those who had a LE injury and those who didn’t. Methods: Thirty-seven adolescent gymnasts (average age: 12.81 years) were included with levels ranging from 5 (novice) to 10 (elite). Participants (15 males and 22 females) were surveyed for previous and current injury. The athletes completed a performance battery before the competition season including: Lower Quarter Y-Balance Test (LQYBT), Closed Kinetic Chain dorsiflexion (CKCDF), single hop (SH), triple hop (TH), and the Functional Movement Screen (FMS). Follow-up data was collected at the end of the competitive season for comparison. The data was analyzed using descriptive methods and comparative analyses including chi-square and independent t-tests with an alpha level set at .05. Results: Sixty-five percent reported an injury in the last year and seventy-eight percent reported pre-season injuries at testing day. The most common location for pre-season injury was the ankle/foot (24% and 31% respectively). There were no differences between injured and non-injured athletes when comparing asymmetries in CKCDF, LQYBT posteromedial or posterolateral reach, hop testing, or FMS. The LQYBT-anterior scores were significantly different at p=.049 between the injured versus uninjured groups, with 91% of the in-season injury group having a difference <4cm. Similarly, the LQYBT-composite score using a cut-off of 95% was significant at p=.043 with those >95% category being more likely to get injured. There were no significant differences in demographic information comparing injury occurrence. Conclusion: The tested physical performance battery may be useful in tracking gymnasts over time, but may not be beneficial in forecasting injuries in a sport with high percentages of acute injuries. The collected injury volume may not be reflective of a standard season as COVID-19 decreased the number of competitions. Additional research to identify athletes at risk for injury requires further investigation.

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Association Between Ball-Handling Versus Defending Actions and Acute Noncontact Lower Extremity Injuries in High School Basketball and Soccer

The American Journal of Sports Medicine ◽

10.1177/0363546514564541 ◽

2015 ◽

Vol 43 (4) ◽

pp. 802-807 ◽

Cited By ~ 9

Author(s):

Scott M. Monfort ◽

R. Dawn Comstock ◽

Christy L. Collins ◽

James A. Onate ◽

Thomas M. Best ◽

...

Keyword(s):

High School ◽

Lower Extremity ◽

Lower Extremity Injuries ◽

Extremity Injuries

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ORTHOPEDIC INJURIES IN ADOLESCENT GYMNASTS: A SYSTEMATIC REVIEW

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00117 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0011

Author(s):

Katie Kim ◽

Michael Saper

Keyword(s):

Lower Extremity ◽

Upper Extremity ◽

Weight Bearing ◽

The Body ◽

Adolescent And Young Adult ◽

Body Region ◽

Lower Extremity Injuries ◽

Common Location ◽

Orthopedic Injuries ◽

Extremity Injuries

Background: Gymnastics exposes the body to many different types of stressors ranging from repetitive motion, high impact loading, extreme weight bearing, and hyperextension. These stressors predispose the spine and upper and lower extremities to injury. In fact, among female sports, gymnastics has the highest rate of injury each year. Purpose: The purpose of this study was to systematically review the literature on location and types of orthopedic injuries in adolescent (≤20 years) gymnasts. Methods: The Pubmed, Medline, EMBASE, EBSCO (CINAHL) and Web of Science databases were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to identify all studies reporting orthopedic injuries in adolescent and young adult gymnasts. All aspects of injuries were extracted and analyzed including location, type and rates of orthopedic injuries. Results: Screening yielded 22 eligible studies with a total of 427,225 patients. Twenty of 22 studies reported upper extremity injuries of which four specifically focused on wrist injuries. Eight studies reported lower extremity injuries. Nine studies reported back/spinal injuries. Seven studies investigated each body location of injury; one study reported the upper extremity as the most common location for injury and six studies reported the lower extremity as the most common location for injury. Of those seven studies, five (23%) reported sprains and strains as the most common injury. One study reported fractures as the most common injury. Conclusion: There is considerable variation in reported injury location. Some studies focused specifically on the spine/back or wrist. The type of gymnastics each patient participated in was also different, contributing to which area of the body was more heavily stressed, or lacking. Current literature lacks data to fully provide evidence regarding which body region is more frequently injured and the type of injury sustained.

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