Shoulder Injuries in Men's Collegiate Lacrosse, 2004-2009

Most cited articles involving lacrosse since 1990 primarily focus on concussion and traumatic brain injury

OBJECTIVES

The purpose of this study was to identify the 50 most-cited publications relating to lacrosse since 1990 and conduct a bibliometric analysis of the identified studies.

METHODS

Clarivate Analytics Web of Science database was queried to identify all publication titles, abstracts, and keywords for the term 'lacrosse' on 9 June 2023. The resulting articles were sorted by total number of citations. Titles and abstracts were included based on their relevance to lacrosse. Once the 50 most cited articles were identified, each article was further analyzed to obtain author name, publication year, country of origin, journal name, article type, research topic, competition level, total number of citations, and the level of evidence. Citation density (total number of citations/years since publication) was calculated and recorded for each of the most-cited studies.

RESULTS

The 50 most-cited articles were cited 4237 of times with an average of 84 citations per article. The most cited article was cited 637 (15.0%) times. The articles came from 2 different countries, with the United States and Australia comprising 49 and 1 articles, respectively. All articles were published in English. The American Journal of Sports Medicine published the most articles (n = 21, 42.0%). The most studied topic was concussion/traumatic brain injury (n = 18) followed by studies assessing all injuries (n = 7). Collegiate-level lacrosse was the most studied level of competition (n = 22), while high school-level followed (n = 12).

CONCLUSIONS

The majority of the 50 most-cited articles related to lacrosse since 1990 focus on the prevalence, diagnosis and identification of concussion/traumatic brain injury in high school and collegiate-level athletes. These articles are predominantly epidemiological or cohort studies with Level III or IV evidence that almost unanimously originate from the United States.

Lacrosse-related injuries in boys and girls treated in U.S. emergency departments, 2000-2016

BACKGROUND

Lacrosse is one of the fastest-growing sports in the United States. Its rules regarding permitted contact differ by sex and age. There are no known studies using a nationally representative data set to analyze lacrosse injury patterns over several years by sex and age in the youth population.

METHODS

A retrospective analysis was performed using data from the National Electronic Injury Surveillance System for youth aged 11-18 years who were treated for lacrosse-related injuries in U.S. emergency departments from 2000 to 2016. Based on our review of the case narratives, we created and coded a new injury-mechanism variable. We generated national estimates from 6406 cases.

RESULTS

An estimated 206,274 lacrosse-related injuries to youths aged 11-18 years were treated in U.S. emergency departments from 2000 to 2016. The rate of injuries per 10,000 significantly increased from 1.9 in 2000 to a peak of 5.3 in 2012 (p < 0.0001), followed by a significant decrease to 3.4 in 2016 (p = 0.020). Injury mechanism, body part injured, and diagnosis differed by sex. Boys were 1.62 times (95% confidence interval (95%CI): 1.25-2.09) more likely than girls to be injured by player-to-player contact. Girls were 2.21 times (95%CI: 1.96-2.49) more likely than boys to have non-contact injuries. Overall, as age increased, the percentage of injuries from lacrosse sticks decreased and player-to-player contact increased.

CONCLUSION

Despite additional protective regulations in the sport, lacrosse is an important source of injury where we continue to see differences by sex and age. This study supports the continuation, modification, and addition of rules aimed at reducing lacrosse injury risk.

Incidence of injuries among lacrosse athletes: a systematic review and meta-analysis

OBJECTIVES

The purpose of this systematic review was to determine the incidence of injuries among lacrosse athletes and the differences in rates of injury by location and gender.

METHODS

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were implemented to conduct this systematic review.[1] The following variables were extracted from each of the included articles: location of injury, gender of patient, and incidence of injury among study population. The methodological quality of the included studies was assessed using mixed-methods appraisal tool (MMAT) version 2018.[2] Estimated rates were reported as pooled proportion with 95% CI. Rates of injury were calculated as a rate per 1000 athletic exposures (AEs), defined as an athlete participating in 1 practice or competition in which he or she was exposed to the possibility of athletic injury.

RESULTS

This study found that the highest injury rate among lacrosse athletes was to the lower leg/ankle/foot with a rate of 0.66 injuries per 1000 AEs (95% CI, 0.51, 0.82). This injury pattern was also found to be the highest among both male and female lacrosse athletes. No statistical significance was detected when comparing rates of injury across gender, regardless of location. The injury pattern with the lowest rates of injury for female athletes being to the shoulder/clavicle and the neck for male athletes.

CONCLUSION

The highest rate of injury among lacrosse athletes was to the lower leg/ankle/foot. As participation in lacrosse continues to rise, there is a greater need for understanding the rate of injury and injury characteristics for physicians and trainers to provide effective care to lacrosse athletes.

Missing The Forest For The Trees: A Lack Of Upper Extremity Physical Performance Testing In Sports Physical Therapy

Background

Despite shoulder and elbow injuries being common in athletics, return to sport and reinjury rates are less than ideal. These outcomes may be driven by the absence of evidence-informed testing to determine an athlete's readiness for sport.

Purpose

The purpose of this study was to explore the reported frequency of physical performance testing for return to sport readiness by physical therapists treating athletes with upper extremity injuries and to identify potential barriers that may limit use of these tests. A secondary aim was to compare practice patterns of clinicians with sports physical therapy specialty certification to clinicians without.

Study Design

International, cross-sectional survey using purposive sampling.

Methods

A survey instrument was created to assess the frequency of use of physical performance tests by physical therapists treating athletes with upper extremity injuries, as well as the barriers limiting the use of these tests. The 19-question online survey was distributed via email and Twitter among sports physical therapists. Independent t-tests and Chi Square analyses were conducted to determine differences in practice patterns between physical therapists with and without specialization and the frequency of potential barriers that may limit the use of these tests.

Results

Four hundred ninety-eight participants met study eligibility and completed the survey. Fewer than half of participants reported using any physical performance test in making return to sport decisions for athletes with upper extremity injuries. The greatest barriers to the use of physical performance tests were a lack of equipment followed by lack of understanding of the literature, lack of time, and lack of supporting literature. Sports specialist clinicians were significantly more likely (p<0.001) to use physical performance tests than non-specialist clinicians (71.6% versus 36.3%).

Conclusion

In this survey of physical therapists (n=498), the majority admit to not using physical performance tests when making return to sport decisions for athletes with upper extremity injuries regardless of specialization.Physical therapists have an opportunity to improve the utilization physical performance testing in the upper extremity athlete in hopes of reducing injury recurrence and enhance return to sport rates.

Level of Evidence

Level 3b.

Men's Lacrosse Injuries in the 2018 International World Championship Play

Background:

Limited data exist on injuries in men’s lacrosse at the international level. As lacrosse’s popularity grows rapidly across the globe, health care providers must understand how to treat lacrosse athletes.

Purpose:

To analyze injury data from the 2018 Men’s World Lacrosse Championship.

Study Design:

Descriptive epidemiology study.

Methods:

This study prospectively observed injuries that occurred during the 2018 Men’s World Lacrosse Championship. The medical staff of each team completed injury report forms, and data were categorized into body part injury, type, mechanism, time, and location of injury.

Results:

Over 11 days, 1019 athletes competed in 170 games, resulting in a total of 7147 athlete-exposures (AEs). A total of 140 injuries were recorded during the tournament for an injury rate of 19.6 per 1000 AEs (95% CI, 16.4-22.7). Overall, there were more contact injuries (n = 99; 70.7%) than noncontact injuries (n = 41; 29.3%) (P < .0001). Contact injuries most commonly affected the upper extremity, while noncontact injuries most commonly affected the lower extremity. Contusions were the most commonly reported injury type in the tournament (n = 41; 29.3%), followed by ligament sprains (n = 32; 22.9%) and muscle strains (n = 21; 15.0%). Although there was no difference between the first and second half of gameplay, the injury rate increased in the latter portion of each half (the first and third quarters vs the second and fourth quarters) (P < .0001). A total of 4 injuries required trips to the hospital.

Conclusion:

Lacrosse has a unique injury profile, as it includes both overhead and collision activity as well as multidirectional, cutting movements. Understanding common injury patterns may help with treatment and prevention. Fatigue may play a role in injury rate, and future research of within-game and within-tournament fatigue should explore this relationship.

Epidemiology of shoulder instability in Italy: A 14-years nationwide registry study

INTRODUCTION

The aim of this study is to estimate the annual number of shoulder dislocation hospitalizations in Italy from 2001 to 2014, to explore geographical variation in access to hospitalizations between the 3 macro-regions of Italy (North, Centre and South) and to perform statistical projections of hospitalizations volumes and rates based on data from 2001 to 2014.

MATERIALS AND METHODS

Data of the Italian Ministry of Health regarding the National Hospital Discharge records (SDO) were analysed for the period of the survey (2001-2014). These data are anonymous and include the patient's age, sex, domicile, region of hospitalization, length of the hospitalization, and type of reimbursement (public or private).

RESULTS

During the 14-year study period, 92,784 hospitalizations to treat shoulder dislocation were performed in Italy, which represented an incidence of 11.2 hospitalizations for every 100,000 Italian inhabitants. 56,514 patients underwent hospitalization for non-surgical treatment. 36,270 patients underwent hospitalization for surgical treatment. The higher hospitalizations rate was among males from 15 to 64 years of age.

CONCLUSIONS

Increasing rates of surgical hospitalization and decreasing rates of hospitalization for non-surgical treatment of shoulder dislocation are observed over a 14-year period. This study confirms that the socioeconomic burden of shoulder dislocation surgery heavily affects the working population. Most shoulder instability procedures were performed on males. The present study provides a description of the frequency and national distribution of shoulder instability in Italy. This study shows an increase in surgical procedures for shoulder instability in Italy.

[Arthroscopically-assisted treatment of acute and chronic dislocations of the acromioclavicular joint : A prospective clinical trial]

BACKGROUND

Injuries of the acromioclavicular joint (ACJ) are frequent and often occur during sports. While arthroscopically-assisted stabilization of acute injuries of the ACJ is a well-established procedure, there is not much data available for arthroscopically-assisted stabilization of chronic injuries of the ACJ.

OBJECTIVES

This study assesses clinical and radiological results of arthroscopically-assisted stabilization of acute and chronic injuries of the ACJ.

MATERIALS AND METHODS

Thirty-six patients with acute and chronic injuries of the ACJ were assessed in a prospective clinical trial. Twenty-five patients with acute injuries (group A) and eleven patients with chronic injuries (group B) were included in this study. Patients of group A were operated using two suture-button systems, while patients of group B received one suture-button system and an autologous gracilis tendon graft.

RESULTS

In group A, the mean preoperative Constant score rated 38, and the ASES score rated 34. At follow-up the Constant score (92) and the ASES score (89) had improved. Panorama views revealed an increased coracoclavicular distance of the affected shoulder (15.8 mm) in comparison to the contralateral shoulder (10.9 mm). In group B, the preoperative Constant score measured 57. It improved to 72 points at follow-up. The ASES score improved from 39 to 72 points in the same period. Panorama views revealed an increased coracoclavicular distance of the affected shoulder (18.9 mm) in comparison to the contralateral shoulder (12.4 mm).

CONCLUSIONS

Stabilization of acute injuries of the ACJ with two suture-button systems is related to very good shoulder function after one year. The native coracoclavicular distance cannot be restored with this procedure. Stabilization of chronic injuries of the ACJ with a suture-button system and an autologous gracilis tendon graft is related to improved shoulder function after one year. However, shoulder function cannot be fully restored with the stabilization technique presented.

Epidemiology of Shoulder Instability Injuries in Collision Collegiate Sports From 2009 to 2014

PURPOSE

To describe the types, mechanisms, and severity of shoulder instability injuries in collegiate collision athletes during the 2009-2010 through 2013-2014 academic years using the National Collegiate Athletic Association Injury Surveillance Program; to compare the injury incidence between men's collision sports and their women's non-collision counterparts, when possible; and to compare injury outcomes between Divisions I, II, and III.

METHODS

Data regarding men's football, wrestling, ice hockey, and lacrosse, as well as women's ice hockey and lacrosse, were obtained. Injuries requiring attention from a health care provider were reported. Incidence rates per 100,000 athlete-exposures (AEs) were calculated with 95% confidence intervals (CIs). Analysis of variance was used to compare time loss (TL), and χ² analysis was used to compare surgery rates between divisions.

RESULTS

A total of 445 shoulder instability injuries occurred in 1,421,561 AEs from 2009-2010 to 2013-2014 (incidence rate, 31.30 injuries/100,000 AEs; 95% CI, 28.4-34.21 injuries/100,000 AEs). Subluxation accounted for 59.1% of injuries, with anterior subluxation (35.3%) being the most common injury. Dislocation resulted in the most TL per injury (17.58 days). Mean TL for all injuries was 8.17 days (standard deviation, 7.21 days). When non-time-loss injuries were excluded from analysis, players experienced a mean TL of 18.34 days (standard deviation, 8.44 days). Divisions I (4.77 days), II (20.52 days), and III (11.23 days) differed significantly in mean TL (P = .01). Of the injuries, 29.3% required surgery. The surgery rates for Divisions I (32.9%), II (38.1%), and III (19.4%) also differed significantly (P = .04). Men's ice hockey and lacrosse players sustained a 2.17-fold (95% CI, 1.04-4.50) higher incidence of shoulder instability than their female counterparts.

CONCLUSIONS

Anterior subluxation and dislocation accounted for 52.1% of all shoulder instability injuries. Injured athletes missed 8 days on average, and nearly 30% of injuries required surgery. Surgery rates and TL were significantly different between Divisions I, II, and III. Female athletes playing non-collision ice hockey and lacrosse experienced significantly lower shoulder instability rates than their male counterparts.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

The First Decade of Web-Based Sports Injury Surveillance: Descriptive Epidemiology of Injuries in US High School Boys' Lacrosse (2008-2009 Through 2013-2014) and National Collegiate Athletic Association Men's Lacrosse (2004-2005 Through 2013-2014)

CONTEXT

The advent of Web-based sports injury surveillance via programs such as the High School Reporting Information Online system and the National Collegiate Athletic Association Injury Surveillance Program has aided the acquisition of boys' and men's lacrosse injury data.

OBJECTIVE

To describe the epidemiology of injuries sustained in high school boys' lacrosse in the 2008-2009 through 2013-2014 academic years and collegiate men's lacrosse in the 2004-2005 through 2013-2014 academic years using Web-based sports injury surveillance.

DESIGN

Descriptive epidemiology study.

SETTING

Online injury surveillance from lacrosse teams of high school boys (annual average = 55) and collegiate men (annual average = 14).

PATIENTS OR OTHER PARTICIPANTS

Boys' and men's lacrosse players who participated in practices and competitions during the 2008-2009 through 2013-2014 academic years in high school or the 2004-2005 through 2013-2014 academic years in college.

MAIN OUTCOME MEASURE(S)

Athletic trainers collected time-loss (≥24 hours) injury and exposure data. Injury rates per 1000 athlete-exposures (AEs), injury rate ratios (IRRs) with 95% confidence intervals (CIs), and injury proportions by body site and diagnosis were calculated.

RESULTS

High School Reporting Information Online documented 1407 time-loss injuries during 662 960 AEs. The National Collegiate Athletic Association Injury Surveillance Program documented 1882 time-loss injuries during 390 029 AEs. The total injury rate from 2008-2009 through 2013-2014 was higher in college than in high school (3.77 versus 2.12/1000 AEs; IRR = 1.78; 95% CI = 1.63, 1.94). Most injuries occurred during competitions in high school (61.4%) and practices in college (61.4%). Injury rates were higher in competitions compared with practices in high school (IRR = 3.59; 95% CI = 3.23, 4.00) and college (IRR = 3.38; 95% CI = 3.08, 3.71). Lower limb injuries, muscle strains, and ligament sprains were common at both levels. Concussion was the most frequent competition diagnosis for all high school player positions.

CONCLUSIONS

Rates of time-loss injury were higher in college versus high school and in competitions versus practices. Attention to preventing common lower leg injuries and concussions, especially at the high school level, is essential to decrease their incidence and severity.

Shoulder and elbow injuries in soccer goalkeepers versus field players in the National Collegiate Athletic Association, 2009-2010 through 2013-2014

OBJECTIVES

Examination of the incidence of shoulder and elbow injuries in the collegiate soccer player population is limited, as is comparison between goalkeepers and field players. We hypothesized that goalkeepers would have a higher incidence of shoulder and elbow injuries than field players. Furthermore, we sought to determine the incidence of shoulder and elbow injuries among National Collegiate Athletic Association (NCAA) soccer players, and to determine injury risk factors.

METHODS

The NCAA Injury Surveillance Program database was analyzed for injuries to NCAA men's and women's soccer players during the 2009-2010 through 2013-2014 academic years. The incidence of injury was calculated per 10,000 athletic exposures (AE) for goalkeepers versus field players, activity, and injury characteristics, and compared using univariate analysis and risk-ratios to determine injury risk factors.

RESULTS

While the overall incidence of shoulder and elbow injuries in soccer players was 2.7/10,000AE [95% CI 2.62-2.78], the incidence among goalkeepers was 4.6-fold higher (8.3 vs. 1.8/10,000AE, p < 0.0001). Goalkeepers had significantly higher incidences of injury in practice (21.3-fold) and in the preseason (16.1-fold) than field players. Women goalkeepers were disproportionately affected, with injury incidences 7.7-fold higher than women field players, and 1.9-fold higher than male goalkeepers. Acromioclavicular joint injuries, rotator cuff tears/sprains, and elbow and shoulder instability constituted the majority of the goalkeeper injuries.

CONCLUSIONS

Shoulder and elbow injuries in NCAA soccer players are significantly more common in goalkeepers than field players. Incidence varies widely by position and injury, with a number of associated risk factors. Soccer players sustaining these injuries, along with their coaches and medical providers, may benefit from this injury data to best manage expectations and outcomes. Soccer governing bodies may use this to track injury incidence and response to preventative measures.

Epidemiology of shoulder and elbow injuries in National Collegiate Athletic Association wrestlers, 2009-2010 through 2013-2014

OBJECTIVES

Examination of the incidence of shoulder and elbow injuries in the collegiate wrestling population is limited. Therefore, we sought to determine the incidence of shoulder and elbow injuries in wrestlers competing in the National Collegiate Athletic Association (NCAA), and investigate the risk factors involved.

METHODS

All shoulder and elbow injuries in wrestlers from the 2009-2010 through 2013-2014 academic years in the NCAA Injury Surveillance Program database were extracted. The incidence of different injuries, sports, activity, time-in-game, competition status, and injury characteristics was recorded. Risk-ratios were calculated to determine risk factors for injury.

RESULTS

Collegiate wrestlers had an incidence of 21.59 shoulder and elbow injuries per 10,000 athletic exposures (AEs). The most frequent injury types included elbow ulnar collateral ligament tears, shoulder impingement, and acromioclavicular joint sprains, although there was significant variability. Freshman collegiate wrestlers suffered a significantly higher percentage of shoulder and elbow injuries than more senior athletes, signifying an association between experience and injury risk. There was a 4-fold higher incidence of injury during competition. Injuries were significantly more likely to occur later in the match, with a 2.5-fold increased risk compared with early. While 26.8% of wrestlers were out of play for at least 14 days, only 5.9% of all injuries required surgery. Lastly, Division I collegiate wrestlers had the highest overall injury rate.

CONCLUSIONS

Collegiate wrestlers have a high incidence of shoulder and elbow injury, with specific risk factors identified here. This at-risk patient population should be monitored closely for signs of fatigue, which may leave them susceptible to injury. Further prospective investigation of wrestling injuries with a special attention to injury prevention in higher risk athletes are needed to further validate these findings.

Characteristics of Operative Shoulder Injuries in the National Collegiate Athletic Association, 2009-2010 Through 2013-2014

Background:

Injuries to the upper extremity among collegiate athletes are reported to account for approximately 20% of all injuries; however, little is known about the proportion of these injuries that require surgery.

Purpose/Hypothesis:

The purpose of this study was to examine all shoulder injuries that required a surgical intervention and were recorded in the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP). We hypothesized that contact would be the mechanism causing injuries most at risk for needing surgery and that dislocations would be the injuries most likely to require an operative intervention.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Injury surveillance data between 2009-2010 and 2013-2014 for operative collegiate shoulder injuries and their associated sport exposures were analyzed.

Results:

A total of 185 operative shoulder injuries occurred over 3,739,004 athlete-exposures (AEs), for an overall incidence of 0.49 per 10,000 AEs. The sports with the highest incidence of operative injuries were men’s football (1.31/10,000 AEs), men’s wrestling (1.14/10,000 AEs), men’s ice hockey (0.60/10,000 AEs), women’s gymnastics (0.44/10,000 AEs), and men’s swimming (0.41/10,000 AEs). Men were significantly more likely than women to sustain operative injuries for all sports combined. Of the injuries that required surgical treatment, superior labrum from anterior to posterior (SLAP) tears (46.4%), other non-SLAP glenoid labrum tears (46.2%), anterior shoulder dislocations (33.3%), and posterior shoulder dislocations (30.0%) were seen most often. There was no significant difference in injury proportion ratios (IPRs) for injuries requiring surgery when comparing contact versus noncontact mechanisms of injury (IPR, 1.0 [95% CI, 0.6-1.6]). The incidence of operative injuries sustained during competition was significantly higher compared with during practice.

Conclusion:

The sports with the highest incidence of operative shoulder injuries were men’s football, men’s wrestling, men’s ice hockey, and women’s gymnastics. Operative shoulder injuries were more likely to occur during competition. SLAP tears, other non-SLAP glenoid labrum tears, and anterior shoulder dislocations had the highest incidence of requiring surgery. Athletes sustaining these injuries, along with their coaches and medical providers, may benefit from identifying collegiate sport participants who are at highest risk for sustaining an operative injury. This may assist in planning medical care and setting expectations, which may be critical to a young athlete’s career.

Season-Ending Shoulder Injuries in the National Collegiate Athletic Association: Data From the NCAA Injury Surveillance Program, 2009-2010 Through 2013-2014

BACKGROUND

Examination of the incidence of shoulder season-ending injury (SEI) in the collegiate athlete population is limited.

PURPOSE

To determine the incidence of shoulder SEI in the National Collegiate Athletic Association (NCAA) and to investigate the risk factors for a shoulder injury ending an athlete's season.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

All shoulder injuries from the NCAA Injury Surveillance Program database for the years 2009-2010 to 2013-2014 were extracted, and SEI status was noted. The incidences of SEI and non-SEI were calculated for athlete, activity, and injury characteristics and compared via univariable analysis and risk ratios to determine risk factors for an injury being season ending.

RESULTS

Shoulder injuries were season ending in 4.3% of cases. The overall incidence of shoulder SEI was 0.31 per 10,000 athlete exposures (AEs), as opposed to 7.25 per 10,000 AEs for all shoulder injuries. Shoulder instability constituted 49.1% of SEI, with an incidence of 0.15 per 10,000 AEs, while fractures had the highest rate of being season ending (41.9%). Men's wrestling had the highest incidence of shoulder SEI (1.65 per 10,000 AEs), while men's soccer had the highest proportion of shoulder injuries that ended a season (14.6%). Overall, men had a 6.3-fold higher incidence of SEI than women and a 2.4-fold increased likelihood that an injury would be season ending.

CONCLUSION

Injury to the shoulder of an NCAA athlete, while somewhat infrequent, can have significant implications on time lost from play. Incidence of these injuries varies widely by sport and injury, with a number of associated risk factors. Athletes sustaining potentially season-ending shoulder injuries, with their coaches and medical providers, may benefit from these data to best manage expectations and outcomes.

Epidemiology of Elbow Ulnar Collateral Ligament Injuries Among Baseball Players: National Collegiate Athletic Association Injury Surveillance Program, 2009-2010 Through 2013-2014

BACKGROUND

Injuries to the ulnar collateral ligament (UCL) of the elbow are of major concern in baseball; however, the epidemiology of these injuries among National Collegiate Athletic Association (NCAA) athletes is poorly described.

PURPOSE

To determine the incidence of UCL injuries in NCAA baseball and investigate the risk factors involved.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

All UCL injuries for academic years 2009-2010 through 2013-2014 were extracted from the NCAA Injury Surveillance Program database. The incidence was calculated for different positions, activity, time in game, competition status, and injury characteristics and compared via injury risk ratios to determine risk factors for injury occurrence. The NCAA provides sampling weights based on division and year. For all other injury characteristic analysis, unweighted data were used.

RESULTS

Over the course of the 2009-2010 to 2013-2014, 20 UCL injuries were reported in the NCAA Injury Surveillance Program over 177,992 athletic exposures (AEs) for an overall incidence of 1.12 per 10,000 AEs (95% CI, 0.63-1.62). Eighty-five percent occurred during throwing, and 100% were new injuries. Of the injuries sustained during games, 28.6% occurred early (warm-up through third inning) and 71.4% late (fourth inning or later), with a risk ratio of 1.3 for late-game injuries (95% CI, 0.24-6.44). Of those injured, 45.0% were able to return to play by the next season, while the remainder were out for at least 7 days. Injury was season ending for 15% of athletes (0.17 per 10,000 AEs), and 15% of athletes required surgery.

CONCLUSION

UCL injury is a potentially season-ending, even career-ending, injury among NCAA baseball players. Additionally, while more injuries occurred later in games, the current study revealed no significant difference in injury rates with respect to time in game. Last, the authors found a higher reported rate of extensive time away from sport after UCL injury than previously published studies on this patient population.

Descriptive Epidemiology of the MOON Shoulder Instability Cohort

BACKGROUND

Shoulder instability is a common diagnosis among patients undergoing shoulder surgery.

PURPOSE

To perform a descriptive analysis of patients undergoing surgery for shoulder instability through a large multicenter consortium.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

All patients undergoing surgery for shoulder instability who were enrolled in the MOON Shoulder Instability Study were included. Baseline demographics included age, sex, body mass index, and race. Baseline patient-reported outcomes (PROs) included the American Shoulder and Elbow Surgeons (ASES) score, Shoulder Activity Score, Western Ontario Shoulder Instability Index (WOSI), 36-Item Health Survey (RAND-36), and Single Assessment Numeric Evaluation (SANE). The preoperative physician examination included active range of motion (ROM) and strength testing. Preoperative imaging assessments with plain radiography, magnetic resonance imaging (MRI), and computed tomography were also included and analyzed.

RESULTS

Twenty-six surgeons had enrolled 863 patients (709 male, 154 female) across 10 clinical sites. The mean age for the cohort was 24 years (range, 12-63 years). Male patients represented 82% of the cohort. The primary direction of instability was anterior for both male (74%) and female (73%) patients. Football (24%) and basketball (13%) were the most common sports in which the primary shoulder injury occurred. No clinically significant differences were found in preoperative ROM between the affected and unaffected sides for any measurement taken. Preoperative MRI scans were obtained in 798 patients (92%). An anterior labral tear was the most common injury found on preoperative MRI, seen in 66% of patients, followed by a Hill-Sachs lesion in 41%. Poor PRO scores were recorded preoperatively (mean: ASES, 72.4; WOSI, 43.3; SANE, 46.6).

CONCLUSION

The MOON Shoulder Instability Study has enrolled the largest cohort of patients undergoing shoulder stabilization to date. Anterior instability is most common among shoulder instability patients, and most patients undergoing shoulder stabilization are in their early 20s or younger. The results of this study provide important epidemiological information for patients undergoing shoulder stabilization surgery.

Risk factors for, and prevention of, shoulder injuries in overhead sports: a systematic review with best-evidence synthesis

Objective

To assess the evidence for risk factors and prevention measures for shoulder injuries in overhead sports.

Design

Systematic review with best-evidence synthesis.

Data sources

Medline (Ovid), PubMed (complementary search), Embase (Elsevier), Cochrane (Wiley), SPORTDiscus (Ebsco) and Web of Science Core Collection (Thomson Reuters), from 1 January 1990 to 15 May 2017.

Eligibility criteria for selecting studies

Randomised controlled trials, cohort studies and case-control studies on risk factors or prevention measures for shoulder injuries in overhead sports. The eligible studies were quality assessed using the Scottish Intercollegiate Guidelines Network criteria.

Results

Of 4778 studies identified, 38 were eligible for quality review and 17 met the quality criteria to be included in the evidence synthesis. One additional quality study presented a shoulder injury prevention programme. Most studies focused on baseball, lacrosse or volleyball (n=13). The risk factors examined included participation level (competition vs training) (n=10), sex (n=4), biomechanics (n=2) and external workload (n=2). The evidence for all risk factors was limited or conflicting. The effect of the prevention programme within the subgroup of uninjured players at baseline was modest and possibly lacked statistical power.

Conclusions

All investigated potential risk factors for shoulder injury in overhead sports had limited evidence, and most were non-modifiable (eg, sex). There is also limited evidence for the effect of shoulder injury prevention measures in overhead sports.

PROSPERO trial registration number

CRD42015026850.

Elbow Dislocation and Subluxation Injuries in the National Collegiate Athletic Association, 2009-2010 Through 2013-2014

Background

Examination of the incidence of elbow dislocation and subluxation injuries in the collegiate athlete population is limited.

Purpose

To determine the incidence of elbow dislocation and subluxation injuries in the National Collegiate Athletic Association (NCAA) and investigate the risk factors involved.

Study Design

Descriptive epidemiology study.

Methods

All elbow subluxation and dislocation injuries from the 2009-2010 through 2013-2014 academic years in the NCAA Injury Surveillance Program database were extracted. The incidence was calculated for different injuries, sports, activity, time in game, competition status, and injury characteristics. Such differences were compared by use of risk ratios to determine risk factors for injury.

Results

The overall incidence of elbow instability injuries was 0.04 per 10,000 athlete-exposures (AEs). Elbow dislocations were more common, with 553 injuries (82.2%, 0.03/10,000 AEs), while elbow subluxations were the minority, with 119 injuries (17.8%, 0.01/10,000 AEs). Men's wrestling had the highest incidence of elbow instability (1.08/10,000 AEs), more than women's gymnastics (0.74), men's football (0.11), and women's volleyball (0.06). All injuries occurred via a contact mechanism, and 99.2% were new injuries. Sixty-nine percent of injuries kept athletes sidelined for more than 2 weeks. Injuries were 3 times more likely to occur in competition (0.08/10,000 AEs) than practice (0.03/10,000 AEs). Injuries sustained during competition were 1.4 times more likely to occur early in the match than late.

Conclusion

Elbow instability injuries are an infrequent but serious source of disability for select NCAA athletes, with a number of associated risk factors. Athletes sustaining these injuries, along with their coaches and medical providers, may benefit from these return-to-play data to best manage expectations and outcomes.

Epidemiology of injuries in men's lacrosse: injury prevention implications for competition level, type of play, and player position

OBJECTIVE

The growth in participation in men's lacrosse has increased the likelihood of sport-specific injuries, yet there continues to be a need for specific epidemiological data concerning lacrosse injuries. The purpose of this literature review is to aggregate available published data on injuries that occur in the sport of men's lacrosse at the youth, high school, collegiate, and professional levels.

METHODS

A comprehensive literature search was performed in PubMed, High Wire Press, SPORTDiscus, Google Scholar, and Ovid, using the keywords Lacrosse Injuries, Epidemiology Lacrosse Injuries, Lacrosse Injury, Lacrosse AND Injury and limited to 1990-2016. All bibliographies were cross-referenced to identify any additional publications. Sources were categorized based on data provided and were aggregated into groups based on reported overall injury rates, rates by setting (competition vs. practice), nature of injury, location, type, severity, and player position.

RESULTS

The game and practice injury rates in college are greater than the rates in high school, similarly rates greater for high school players than in youth leagues. Rates of injury varied from 0.095-12.98 per 1000 athlete exposures. Game injury rates were higher across all studies. Injuries in men's lacrosse occur most often from player-to-player contact, which result in immediate injuries, such as concussions, contusions, and lacerations. Overall concussion incidence was reported to range from 0.11-0.84 per 1000 AE. The most common types of injuries were sprain, strain, concussion, and contusions and the most common area of injury was hand (23%), with a significant proportion of these (59.4%) being to the thumb. Limited evidence of different injuries among the player positions suggests there might be a pattern that midfield players had the most injuries, followed by offensive players and then defensive players.

CONCLUSIONS

The potential for sports-related injury is of relative concern; especially considering rising participation and total number of injuries. Further development and proper enforcement of safety rules on player contact and protective equipment are recommended to decrease the rate of lacrosse-related injury. Additional longitudinal research is needed to better classify and to ultimately predict lacrosse injury factors and mechanisms across all levels of play.

The epidemiology of NCAA men's lacrosse injuries, 2009/10-2014/15 academic years

Background

Participation in lacrosse has grown at the collegiate levels. However, little research has examined the epidemiology of collegiate men’s lacrosse injuries. This study describes the epidemiology of injuries in National Collegiate Athletic Association (NCAA) men’s lacrosse during the 2009/10–2014/15 academic years.

Methods

Twenty-five men’s lacrosse programs provided 63 team-seasons of data for the NCAA Injury Surveillance Program (NCAA-ISP) during the 2009/10–2014/15 academic years. Injuries occurred from participation in an NCAA-sanctioned practice or competition, and required attention from an AT or physician. Injuries were further classified as time loss (TL) injuries if the injury restricted participation for at least 24 h. Injuries were reported through electronic medical record application used by the team medical staff throughout the academic year. Injury rates per 1000 athlete-exposures (AE), injury rate ratios (RR), 95% confidence intervals (CI), and injury proportions were reported.

Results

Overall, 1055 men’s lacrosse injuries were reported, leading to an injury rate of 5.29/1000AE; 95%CI: 4.98–5.61. The TL injury rate was 2.74/1000AE (95%CI: 2.51–2.96). The overall injury rate was higher in competition than practice (12.35 vs. 3.90/1000AE; RR = 3.16; 95%CI: 2.79–3.58). Most injuries were to the lower extremity (58.3%), particularly the ankle (14.1%) in competition and the upper leg (14.3%) in practice. Sprains and strains were the most common diagnoses in both competition (26.9 and 23.7%, respectively) and practice (20.2% and 27.4%, respectively). Most injuries in competitions and practices were due to player contact (32.8 and 17.5%, respectively) and non-contact (29.6 and 40.0%, respectively).

Conclusions

Our estimated injury rates are lower than those from previous college men’s lacrosse research. This may be due to increased injury awareness, advances in injury prevention exercise programs, or rule changes. Still, injury prevention can aim to continue reducing the incidence and severity of injury, particularly those sustained in competitions and to the lower extremity.