Video Analysis of Shoulder Dislocations in Rugby: Insights Into the Dislocating Mechanisms

Postoperative Variations in Shoulder Biomechanics and Kinematics in the Abduction and External Rotation Position After Remplissage With Bankart Repair for Anterior Glenohumeral Instability: A Finite Element Analysis

Background

Remplissage with Bankart repair (RMBR) is an arthroscopic procedure performed on <25% of Bankart lesions with off-track Hill-Sachs lesions (HSLs) that alters the insertion of the infraspinatus muscle into the humeral head. However, the effects of RMBR surgery on humeral head displacement due to changes in biomechanics and kinematics have not been fully elucidated.

Purpose

To evaluate how the biomechanical and kinematic effects of the post-RMBR glenohumeral joint influence humeral head displacement using the finite element analysis (FEA) method.

Study Design

Controlled laboratory study.

Methods

Biomechanical and kinematic experiments were performed on 24 established finite element (FE) models, which included 12 normal glenohumeral joint models and 12 post-RMBR glenohumeral joint models at the abduction and external rotation (ABER) position. FEA was used to compute the total displacement of the humeral head during passive anteroinferior loading and active contraction of the infraspinatus muscle.

Results

Under passive anteroinferior loading, the humeral heads showed less total anterior displacement after RMBR than did normal glenohumeral joints in the ABER position (1.94 ± 0.48 vs 5.19 ± 1.91 mm; P = .003). When the infraspinatus muscle was stimulated to contract, the humeral heads of post-RMBR glenohumeral joints exhibited greater total posterior displacement in the ABER position than did the normal glenohumeral joints (4.22 ± 0.23 vs 2.44 ± 0.56 mm; P < .001).

Conclusion

Displacement of the humeral head is influenced by changes in the insertion of the infraspinatus tendon after RMBR surgery, which consequently affects the lever arm and torque generated by the infraspinatus muscle on the humeral head.

Clinical Relevance

The FEA results confirmed that a change in the insertion of the infraspinatus tendon alters the lever arm and torque produced by the infraspinatus muscle on the humeral head. This leads to changes in the displacement of the humeral head in the ABER position after the RMBR procedure. These findings deepen the understanding of RMBR surgery in clinical practice and can assist physicians in deciding whether to choose this surgical approach in patients with combined HSL.

Systematic video analysis of shoulder dislocations in professional male football (soccer): Injury mechanisms, situational and kinematic patterns

Purpose

Shoulder dislocations in professional football are severe injuries with an increasing incidence and considerable layoff times. Unlike other football injuries, the mechanisms leading to shoulder dislocations are not well understood, which limits the development of targeted preventive measures. Thus, the aims of this study were: (1) to analyse injury mechanisms of shoulder dislocations in professional football, (2) to evaluate situational and (3) to assess kinematic patterns by performing a systematic video analysis.

Methods

The study included all shoulder dislocations occurring in official matches within Germany's top two professional male football (soccer) leagues (1. and 2. Bundesliga) from the 2012/2013 to the 2022/2023 seasons. A systematic video analysis was performed using the official Bundesliga video database. Two independent reviewers assessed injury-related, situational and kinematic parameters.

Results

A total of 37 shoulder dislocations in 36 players (mean age 25 years) were analysed. Two primary injury mechanisms were identified: Type 1 mechanisms, caused by direct contact to the upper extremity (n = 14), and Type 2 mechanisms, caused by catching a fall (n = 22). Only one case did not fit these categories. Median layoff times were 94 days for Type 1 and 56 days for Type 2, but this difference was not statistically significant. Statistically significant differences between the two types were found in player action (p < 0.001) and type of contact (p = 0.005), while factors like player's speed, movement direction, football-specific actions, ball possession and pitch location showed no statistically significant differences. On-field treatment methods varied, but there were no statistically significant differences in repositioning attempts or reduction techniques (n.s.). Trunk position, shoulder joint version, shoulder elevation, and rotation, as well as elbow and wrist joint positions at the moment of dislocation, were similar between the two types (n.s.).

Conclusion

Shoulder dislocations in professional football typically occur through direct contact or catching a fall, indicating a potential role for specific preventive measures.

Level of Evidence

Level III.

Tacklers' shoulder abduction and flexion at contact alter when engaging in different front-on, one-on-one tackle instructions from an expert coach

OBJECTIVES

To ascertain how the three-dimensional shoulder kinematics of tacklers alter when performing four legal types of front-on, one-on-one, rugby-style torso tackles.

DESIGN

Controlled laboratory study.

METHODS

Three-dimensional motion capture measured 15 male amateur-level rugby code players (24.3 ± 6.1 years) who were instructed by an expert coach to perform four sets of 10 front-on, one-on-one tackles. Four sets comprised two smother and two dominant tackles: two based on the Australian National Rugby League coaching manual (Dominant NRL, Smother NRL); and two modifications via increasing the contact height from the lower- to mid-torso (Dominant, Torso Stick) or from the upper- to mid-upper torso with a vertical 'pop action' that changes the way the tackler contacted the ball carrier's upper torso (Smother, Pop, Lock). Mixed general linear models were applied.

RESULTS

Greater shoulder abduction, flexion and internal rotation were displayed by the DNRL tackle technique than in any other technique (p < 0.001). At contact, the Smother and Dominant NRL (p < 0.03) showed greater head-uptrunk contralateral rotation away from the tackle than the Smother, Pop, Lock.

CONCLUSIONS

Tacklers modified the way they positioned their shoulder joint when engaging in legal front-on, one-on-one tackles with different tackle instructions. More prominent positions of shoulder abduction and flexion, and head-uptrunk contralateral rotation were observed when executing the traditional tackle techniques (Smother NRL, Dominant NRL) as opposed to two variants of these (Smother, Pop, Lock, Dominant, Torso Stick). Inclusion of tackle specific coaching instructions provides emerging scientific evidence to support revised coaching tackling technique interventions that might enhance player safety.

Glenohumeral morphological predictors of recurrent shoulder instability following arthroscopic Bankart repair

PURPOSE

The purpose of this study was to evaluate glenohumeral morphological features on a magnetic resonance arthrogram (MRA) to determine risk factors for recurrence of anterior shoulder instability following arthroscopic Bankart repair (ABR).

METHODS

A retrospective review of patients who underwent ABR between 2012 and 2017 was performed to identify patients who had recurrence of instability following stabilisation (Group 1). These were pair-matched in a 2:1 ratio for age, gender and sport with a control (Group 2) who underwent ABR without recurrence. Preoperative MRAs were evaluated for risk factors for recurrence, with glenoid bone loss and Hill-Sachs lesions also measured. Multilinear and multilogistic regression models were used to evaluate factors affecting recurrence.

RESULTS

Overall, 72 patients were included in this study, including 48 patients without recurrence and 24 patients with recurrent instability. There was a significant difference between the two groups in mean glenoid bone loss (Group 1: 7.3% vs. Group 2: 5.7%, p < 0.0001) and the rate of off-track Hill-Sachs lesions (Group 1: 20.8% vs. Group 2: 0%, p = 0.0003). Of the variables analysed in logistic regression, increased glenoid anteversion (p = 0.02), acromioclavicular (AC) degeneration (p = 0.03) and increased Hill-Sachs width were associated with increased risk of failure. Increased chondral version (p = 0.01) and humeral head diameter in the anteriorposterior view were found to be protective and associated with a greater likelihood of success.

CONCLUSION

Glenoid anteversion was a risk factor for recurrent instability, whereas increased chondral version and humeral head diameter were associated with higher rates of success following ABR. Glenoid bone loss, presence of an off-track Hill-Sachs lesion, increased Hill-Sachs width and AC degeneration were also associated with failure. These findings should be used by surgeons to stratify risk for recurrence following ABR.

LEVEL OF EVIDENCE

Level III.

Normative values for internal and external glenohumeral rotation strength in rugby players: A systematic review with meta-analysis

This systematic review aims to provide normative values for internal and external glenohumeral rotation strength in rugby players. From the inception to March 2021, the search strategy was (strength OR torque) AND shoulder AND rugby using PubMed, Scopus, Web of Science, and SPORTDiscus databases, with no language restrictions. This systematic review includes 15 articles involving 573 rugby players and presenting internal or external glenohumeral rotation strength values. Two main methods are used to assess glenohumeral rotation strength in rugby players: isokinetic and isometric methods; in the isometric method, the upper arm is abducted at either 0° or 90°. Owing to differences in isokinetic procedures and a lack of studies assessing isometric strength when the upper arm is in a neutral position, normative internal or external glenohumeral rotation strength values are only provided for isometric contractions when the upper arm is abducted at 90° based on 311 shoulders of 163 male rugby union players, with 2.04 ± 0.15 N.kg-1 and 2.11 ± 0.13 N.kg-1 for internal and external glenohumeral rotation strength, respectively. These findings may help strength and conditioning coaches and physical therapists, provide objective evidence when deciding whether or not rugby union players should return to sport.

Development of a rugby shoulder function (RSF) questionnaire: An online Delphi study

OBJECTIVE

Develop a questionnaire to monitor symptoms of player perceived shoulder function/dysfunction.

DESIGN

3-Stage Online Delphi Study.

METHODS

Participants: surgeons, sports and exercise medics, academic researchers, strength and conditioning coaches, therapists and athletes split by level of expertise/experience. Stage-1: experts (n = 12) rated constructs/items from the steering group and made changes/proposed additional constructs/items. Stage-2: experts rated/amended new constructs/items from stage-1. Stage-3: experienced professionals (n = 25) rated/ranked constructs/items from stage 2. Consensus thresholds were defined per stage (≥50% agreement/4-5 rating on 1-5 Likert scale (stages 1-2), ≥68% agreement, and items ranked for perceived importance (stage-3)).

RESULTS

Stage-1, all four constructs (a. Activities of daily living, b. Range of motion, c. Strength and conditioning, d. Sports specific training and competition) and 26/42 original items achieved consensus. Twelve items were combined into five items. Four new items were also proposed. Stage-2, the combined items and three of the four new items achieved consensus. Stage-3 the four constructs and 22 items all achieved consensus.

CONCLUSIONS

Following a 3-stage online Delphi process, involving expert and experienced clinicians, practitioners and athletes, a new four construct, 22 item RSF questionnaire has been developed which can be used with rugby players, to monitor perceived shoulder performance and symptoms.

Injury Trends for School Rugby Union in Ireland: The Need for Position-specific Injury-prevention Programs

BACKGROUND

Concern has been raised over the injury risk to school Rugby union (Rugby) players and the potential long-term health consequences. Despite the increase in studies for this cohort, the influence of playing position on injury incidence and presentation is unclear.

PURPOSE

To describe the incidence, nature and severity of match injuries for school Rugby in Ireland overall, and as a function of playing position.

STUDY DESIGN

Prospective cohort study.

METHODS

Data were collected from 15 male (aged 16-19 years) school Senior Cup teams across 2 seasons. In total, 339 players participated in season 1, whereas 326 players participated in season 2. Injury data were recorded onto a bespoke online platform. Match exposure was also recorded.

RESULTS

The incidence rate of match injuries (24-hour time loss) was 53.6 per 1000 hours. Across both seasons, 6810 days were lost from play due to injury. Forwards (65.4 per 1000 hours) sustained significantly more (P < 0.05) injuries than backs (40.5 per 1000 hours). The head, shoulder, knee, and ankle were the most common injured body regions; however, forwards sustained significantly more (P < 0.05) head and shoulder injuries than backs. The tackle was responsible for the majority of injuries in both groups. The highest proportion of injuries occurred during the third quarter.

CONCLUSION

Clear differences in injury presentation and incidence were evident when comparing forwards versus backs. The high rate of head and shoulder injuries in the forwards suggest the need for more targeted injury-prevention strategies and further research on education and laws around the tackle event. The spike of injuries in the third quarter suggests that fatigue or inadequate half-time warm-up may be a contributing factor warranting further exploration.

CLINICAL RELEVANCE

This study demonstrates clear differences in injury presentation according to playing position in school Rugby and highlights the need for a more tailored approach to the design and implementation of injury-prevention strategies.

LEVEL OF EVIDENCE

Level 3.

Glenoid Track Width Is Smaller Under Dynamic Conditions: An In Vivo Dual-Fluoroscopy Imaging Study

BACKGROUND

The glenoid track concept has been widely used to assess the risk of instability due to bipolar bone loss. The glenoid track width was commonly used as 83% of the glenoid width to determine if a lesion was on-track or off-track. However, the value was obtained under static conditions, and it may not be able to reflect the actual mechanism of traumatic dislocation during motion.

PURPOSE

To compare the glenoid track width under dynamic and static conditions using a dual-fluoroscopic imaging system.

STUDY DESIGN

Controlled laboratory study.

METHODS

In total, 40 shoulders of 20 healthy volunteers were examined for both dynamic and static tests within a dual-fluoroscopic imaging system at 5 different arm positions: 30°, 60°, 90°, 120°, and 150° of abduction, keeping the shoulder at 90° of external rotation. The participants performed a fast horizontal arm backswing for dynamic tests while keeping their arm in maximum horizontal extension for static tests. Computed tomography scans were used to create 3-dimensional models of the humerus and scapula for 2-dimensional to 3-dimensional image registration. Magnetic resonance imaging scans were obtained to delineate the medial margin of the rotator cuff insertion. The glenoid track width was measured as the distance from the anterior rim of the glenoid to the medial margin of the rotator cuff insertion and compared between static and dynamic conditions.

RESULTS

The mean glenoid track widths at 30°, 60°, 90°, 120°, and 150° of abduction were significantly smaller under dynamic conditions (88%, 81%, 72%, 69%, and 68% of the glenoid width) than those under static conditions (101%, 92%, 84%, 78%, and 77% of the glenoid width) (all P < .001). The glenoid track width significantly decreased with the increasing abduction angles in the range of 30° to 120° under static conditions (all P < .003) and 30° to 90° under dynamic conditions (all P < .001).

CONCLUSION

A smaller dynamic-based value should be considered for the glenoid track width when distinguishing on-track/off-track lesions. Clinical evidence is needed to establish the superiority of the dynamic-based value over the static-based value as an indicator for augmentation procedures.

CLINICAL RELEVANCE

Some off-track lesions might be misclassified as on-track lesions when the original commonly used static-based value of 83% is used as the glenoid track width.

Video Analysis of Pectoralis Major Injuries in Professional Australian Football Players

Background:

There is little evidence regarding the mechanisms of pectoralis major (PM) injury and player outcomes in Australian Football League (AFL) players.

Purposes/Hypothesis:

The study aims were to investigate (1) the mechanisms of PM muscle injury in elite AFL players via video analysis and (2) the player profile, method of management, and clinical outcomes of the PM injuries sustained. We hypothesized that the majority of PM tears would occur in outer-range PM positions (hyperextension of the glenohumeral joint).

Study Design:

Case series; Level of evidence, 4.

Methods:

We analyzed video of the precipitating event for traumatic PM injuries during AFL competition or training over a 20-year period (2002-2021). The footage was analyzed by 4 experienced assessors, and the following were evaluated: mechanism of injury, injury variables (arm position, initial contact point, visual awareness, and use of taping), player characteristics (age at the time of injury, hand dominance, and history of injury), injury profile (location and size of tear), method of management (operative vs nonoperative), patient outcomes (time to return to full senior training/match play), and complication rates.

Results:

The mean ± standard deviation age of the players was 26.5 ± 3.1 years (range, 21-32 years). Overall, 22 PM injuries were identified in the AFL injury database for a rate of 1.1 per year; 16 of these injuries had accompanying video footage. We identified 3 mechanisms for PM injury: horizontal hyperextension (62.5%), hyperflexion-abduction (25.0%), and horizontal adduction (sustained tackling; 12.5%). The most common site of the tear was the insertion point of the sternocostal head (91.0%). Twenty players (91.0%) required surgical repair, with 75% undergoing surgery within 1 week (range, 0-26 weeks). The mean return to competition for the surgical repair group was 11.1 weeks (range, 8-15 weeks). The rerupture rate was 5.0% (1 repair; <4 weeks postoperatively in 2004).

Conclusion:

PM tears in elite male AFL players were due to 1 of 3 distinct mechanisms: horizontal hyperextension, hyperflexion-abduction, and horizontal adduction (sustained tackling). Players returned to play on average 11 weeks after injury. Knowledge regarding mechanisms of injury, player profile, and return-to-sport timelines is important for appropriate medical management and provides potential areas to target for prevention of PM injuries.

Angle-Specific Isokinetic Shoulder Rotational Strength Can be Reliably Assessed in Collision and Contact Athletes

An increased understanding of rotational strength as a potential prognostic factor for injury in contact and collision athletes may be important in planning return to sport. The aim of this study was to (1) determine the test-retest reliability of clinically relevant, angle-specific rotational and peak torque measurements in a cohort of uninjured collision and contact athletes; (2) develop a normal descriptive profile of angle-specific rotational torque measurements in the same cohort; and (3) examine the effects of direction and joint angle on shoulder rotational strength interlimb asymmetries. Twenty-three collision and contact athletes were recruited for the interday reliability substudy and 47 athletes were recruited for the remaining substudies. We used intraclass correlation coefficients with 95% confidence intervals to quantify interday reliability of all variables. We used a 2-way repeated-measures analysis of variance to analyze differences in absolute interlimb asymmetries. Interday reliability for the isokinetic strength variables was good to excellent (0.78-0.90) on the dominant side and moderate to good (0.63-0.86) on the nondominant side. Maximum angle-specific torque (as well as peak torque) can be measured reliably in internally and externally rotated positions. A normal profile of clinically relevant, angle-specific shoulder rotational torque measurements for collision and contact athletes has been established which provides a reference when assessing shoulder strength in this population.

The playing position significantly influences return to sports and recurrences after an arthroscopic Bankart repair in competitive rugby players

BACKGROUND

The purpose of our study was to investigate the influence of the different rugby playing positions on return to sports, functional outcomes, and recurrences after an arthroscopic Bankart repair.

METHODS

A total of 88 rugby players were treated for anterior shoulder instability in our institution between 2010 and 2018. Functional outcomes, return to sports, recurrences, complications, and revisions rates were evaluated according to the playing position.

RESULTS

Overall, 73.8% of the patients returned to rugby and 60% returned at the same level as before the injury. The tight forwards and outside backs experienced a significant decrease in their competitive level after surgery, and showed the lowest functional outcomes. The tight forwards and outside backs showed a statistically significant increase in recurrence and revision rates, and an OR for recurrence of 12.8 and 9.6, respectively.

DISCUSSION

The playing position significantly influenced return to sports and recurrences after an arthroscopic Bankart repair in competitive rugby players. Specifically, the tight forwards and outside backs have returned to a lower level than they had before surgery, showed the lowest functional outcomes, and a significant increase in recurrences and revisions rates than the other groups.

Translations of the Humeral Head Elicit Reflexes in Rotator Cuff Muscles That Are Larger Than Those in the Primary Shoulder Movers

Muscle activation helps stabilize the glenohumeral joint and prevent dislocations, which are more common at the shoulder than at any other human joint. Feedforward control of shoulder muscles is important for protecting the glenohumeral joint from harm caused by anticipated external perturbations. However, dislocations are frequently caused by unexpected perturbations for which feedback control is essential. Stretch-evoked reflexes elicited by translations of the glenohumeral joint may therefore be an important mechanism for maintaining joint integrity, yet little is known about them. Specifically, reflexes elicited by glenohumeral translations have only been studied under passive conditions, and there have been no investigations of how responses are coordinated across the functional groupings of muscles found at the shoulder. Our objective was to characterize stretch-evoked reflexes elicited by translations of the glenohumeral joint while shoulder muscles are active. We aimed to determine how these responses differ between the rotator cuff muscles, which are essential for maintaining glenohumeral stability, and the primary shoulder movers, which are essential for the large mobility of this joint. We evoked reflexes using anterior and posterior translations of the humeral head while participants produced voluntary isometric torque in six directions spanning the three rotational degrees-of-freedom about the shoulder. Electromyograms were used to measure the stretch-evoked reflexes elicited in nine shoulder muscles. We found that reflex amplitudes were larger in the rotator cuff muscles than in the primary shoulder movers, in part due to increased background activation during torque generation but more so due to an increased scaling of reflex responses with background activation. The reflexes we observed likely arose from the diversity of proprioceptors within the muscles and in the passive structures surrounding the shoulder. The large reflexes observed in the rotator cuff muscles suggest that feedback control of the rotator cuff augments the feedforward control that serves to compress the humeral head into the glenoid. This coordination may serve to stabilize the shoulder rapidly when preparing for and responding to unexpected disturbances.

Its not all about sprinting: mechanisms of acute hamstring strain injuries in professional male rugby union—a systematic visual video analysis

Objectives

The mechanisms of hamstring strain injuries (HSIs) in professional Rugby Union are not well understood. The aim of this study was to describe the mechanisms of HSIs in male professional Rugby Union players using video analysis.

Methods

All time-loss acute HSIs identified via retrospective analysis of the Leinster Rugby injury surveillance database across the 2015/2016 to 2017/2018 seasons were considered as potentially eligible for inclusion. Three chartered physiotherapists (analysts) independently assessed all videos with a consensus meeting convened to describe the injury mechanisms. The determination of the injury mechanisms was based on an inductive process informed by a critical review of HSI mechanism literature (including kinematics, kinetics and muscle activity). One of the analysts also developed a qualitative description of each injury mechanism.

Results

Seventeen acute HSIs were included in this study. Twelve per cent of the injuries were sustained during training with the remainder sustained during match-play. One HSI occurred due to direct contact to the injured muscle. The remainder were classified as indirect contact (ie, contact to another body region) or non-contact. These HSIs were sustained during five distinct actions—‘running’ (47%), ‘decelerating’ (18%), ‘kicking’ (6%), during a ‘tackle’ (6%) and ‘rucking’ (18%). The most common biomechanical presentation of the injured limb was characterised by trunk flexion with concomitant active knee extension (76%). Fifty per cent of cases also involved ipsilateral trunk rotation.

Conclusion

HSIs in this study of Rugby Union were sustained during a number of playing situations and not just during sprinting. We identified a number of injury mechanisms including: ‘running’, ‘decelerating’, ‘kicking’, ‘tackle’, ‘rucking’ and ‘direct trauma’. Hamstring muscle lengthening, characterised by trunk flexion and relative knee extension, appears to be a fundamental characteristic of the mechanisms of acute HSIs in Rugby Union.

Analysis of patients unable to return to play following arthroscopic Bankart repair

PURPOSE

The purpose of this study was to analyze patients that did not return to play (RTP) following arthroscopic Bankart repair (ABR) compared to those who did RTP, and analyze factors associated with not returning to play.

METHODS

A retrospective review of patients who underwent ABR, and subsequently did not RTP after a minimum of 24-month follow-up was performed. Additionally, these were pair matched in a 3:1 ratio for age, gender, sport and level of pre-operative play with a control group who RTP. Patients were evaluated for their psychological readiness to return to sport using the SIRSI score. Multivariate regression models were used to evaluate factors affecting RTP.

RESULTS

The study included a total of 52 patients who were unable to RTP and 156 who returned to play. Ten patients (19.2 %) who did not RTP passed the SIRSI benchmark of 56 with a mean overall score of 39.8 ± 24.6, in those who returned 73.0 % passed the SIRSI benchmark of 56 with a mean overall score of 68.9 ± 22.0 (p < 0.0001 for both). The most common primary reasons for not returning were 27 felt physically unable to return, whilst 21 felt it was a natural end to their career or their lifestyle had changed. Multi-logistic regression revealed that 4 of the 12 components of the SIRSI score (p < 0.05 for all) and SSV (p = 0.0049), were the factors that were associated with RTP.

CONCLUSION

Following ABR, those that do not return to play exhibit poor psychological readiness to return to play, with multi-linear regression revealing the SIRSI questions associated with fear of re-injury were associated with a lower rate of RTP. Additionally, functional limitations were found to be associated with a lower rate of RTP.

LEVEL OF EVIDENCE

Level III; Retrospective Comparative Cohort Study.

Epidemiology of Shoulder Injuries in Schoolboy Rugby Union in Ireland

BACKGROUND

The shoulder has been reported as a frequent location of injury in adult professional and amateur rugby, with match injury incidence rates ranging from 1.8 to 3 per 1000 player-hours (h). An increased understanding of the incidence and mechanism of shoulder injuries in school rugby players is vital to establish effective injury preventive strategies and advise on appropriate rehabilitation.

PURPOSE

To describe the incidence, nature, and severity of shoulder injuries in schoolboy rugby in Ireland.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

Injury surveillance was carried out for Senior Cup teams across two seasons (N = 665 players aged 17-19 years) in Ireland from 2018 to 2020. Match and training injury data were recorded using an online system by trained nominated injury recorders. Match exposure was also recorded.

RESULTS

Shoulder match injury incidence was 12.2 per 1000 h (95% CI, 9.1-16.2), with a mean severity of 47 days' time loss and an overall burden of 573 days per 1000 h. In total, 47 match and 5 training shoulder injuries were recorded. The most common injuries were shoulder dislocations/subluxations (34%), followed by acromioclavicular joint sprains (30%). Shoulder dislocations/subluxations represented the most burdensome injury (280 days per 1000 h). The tackle accounted for the majority (81%) of shoulder injuries. Forwards sustained a significantly higher incidence of shoulder injuries (8.3/1000 h) in comparison with backs (3.9/1000 h), with a rate ratio of 2.13 (95% CI, 1.15-3.94; P = .015).

CONCLUSION

We found a notably higher injury incidence rate in schoolboy rugby as compared with the adult amateur and professional game. Shoulder injuries were responsible for more days lost than any other injury, and shoulder dislocations were the most severe. This is of particular concern so early in a player's career and warrants further investigation into potential risk factors and mechanisms associated with shoulder injuries in school-age players.

Biomechanical upper-extremity performance tests and isokinetic shoulder strength in collision and contact athletes

The aim of this study was threefold (1) to assess the reliability of three upper-extremity performance tests: a countermovement push up, press jump and drop box land, performed on a set of dual-force plates (2) to examine whether there was an association between isokinetic dynamometry and the performance tests in a non-injured cohort of collision/contact athletes and (3) to establish a normal descriptive profile of the vertical ground reaction forces from the performance tests, in a cohort of contact/collision athletes. The study was split into two sub-sections; the inter-day reliability of three upper-extremity performance tests (n = 21) and a descriptive, correlation study investigating the relationship between isokinetic dynamometry and performance tests metrics (n = 39). We used intraclass correlation coefficients (absolute agreement, 2-way mixed-effects model) with 95% confidence intervals to quantify inter-day reliability of all variables. We used Pearson correlation coefficients to investigate associations between isokinetic strength and vertical ground reaction force asymmetry variables. Inter-day reliability was moderate-to-excellent for the upper-extremity performance tests (ICC 0.67-0.97). There was no statistically significant correlation between external and internal rotational peak torque and the variables of CPMU, PJ and BDL (r range = .02-.24).These upper-extremity tests are reliable for use with male contact/collision athletes.

Recurrence and Revision Rates With Arthroscopic Bankart Repair Compared With the Latarjet Procedure in Competitive Rugby Players With Glenohumeral Instability and a Glenoid Bone Loss <20

BACKGROUND

There is a lack of evidence in the literature comparing outcomes between the arthroscopic Bankart repair and the Latarjet procedure in competitive rugby players with glenohumeral instability and a glenoid bone loss <20%.

PURPOSE

To compare return to sport, functional outcomes, and complications between the arthroscopic Bankart repair and the Latarjet procedure in competitive rugby players with glenohumeral instability and a glenoid bone loss <20%.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Between June 2010 and February 2018, 130 competitive rugby players with anterior shoulder instability were operated on in our institution. The first 80 patients were operated on with the arthroscopic Bankart procedure and the other 50 with the open Latarjet procedure. Return to sport, range of motion (ROM), the Rowe score, and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences, reoperations, and complications were also evaluated.

RESULTS

In the total population, the mean follow-up was 40 months (range, 24-90 months) and the mean age was 24.2 years (range, 16-33 years). Ninety-two percent of patients were able to return to rugby, 88% at their preinjury level of play. Eighty-nine percent of patients in the Bankart group and 87% in the Latarjet group returned to compete at the same level (P = .788). No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe and ASOSS scores showed statistical improvement after operation (P < .01). No significant difference in functional scores was found between the groups The Rowe score in the Bankart group increased from a preoperative mean (± SD) of 41 ± 13 points to 89.7 points postoperatively, and in the Latarjet group, from a preoperative mean of 42.5 ± 14 points to 88.4 points postoperatively (P = .95). The ASOSS score in the Bankart group increased from a preoperative mean of 53.3 ± 3 points to 93.3 ± 6 points postoperatively, and in the Latarjet group, from a preoperative mean of 53.1 ± 3 points to 93.7 ± 4 points postoperatively (P = .95). There were 18 recurrences (14%). The rate of recurrence was 20% in the Bankart group and 4% in the Latarjet group (P = .01). There were 15 reoperations (12%). The rate of reoperation was 16% in the Bankart group and 4% in the Latarjet group (P = .03). There were 6 complications (5%). The rate of complications was 4% in the Bankart group and 6% in the Latarjet group (P = .55). The proportion of postoperative osteoarthritis was 10% in the Bankart group (8/80 patients) and 12% (6/50 patients) in the Latarjet group (P = .55).

CONCLUSION

In competitive rugby players with glenohumeral instability and a glenoid bone loss <20%, both the arthroscopic Bankart repair and the Latarjet procedure produced excellent functional outcomes, with most athletes returning to sport at the same level they had before the injury. However, the Bankart procedure was associated with a significantly higher rate of recurrence (20% vs 4%) and reoperation (16% vs 4%) than the Latarjet procedure.

Magnetic Resonance Arthrography in Rugby Players Undergoing Shoulder Stabilization for Glenohumeral Instability: Professionals Have Higher Frequencies of More Pathologies

Purpose

To quantify the magnetic resonance arthrography (MRA) findings in rugby players during preoperative workup for anterior surgical stabilization for glenohumeral instability.

Methods

All patients who underwent glenohumeral instability surgery in our institution between 2008 and 2018 were considered for inclusion. Rugby players were identified using the patient's medical notes, with subsequent identification of all professional players. All rugby player's preoperative MRA findings were recorded and analyzed.

Results

Overall, 267 rugby players were included, 261 of whom were male (97.8%), with a mean age of 22.7 years (range 13-55 years). There were 58 professional rugby players (21.7%). The mean number of pathologies in nonprofessional rugby players was 5.0 pathologies versus 6.2 pathologies in the professional rugby players, with a significant difference in nonprofessional rugby players with up to 3 pathologies versus professional rugby players (26.3% vs 10.3%, P = .01). Professional rugby players had a statistically significant increased incidence of bicipital tendon lesions (25.9% vs 13.9%, P = .009), acromioclavicular joint degeneration (60.3% vs 42.1%, P = .016), glenohumeral bone loss (87.9% vs 69.9%, P = .006), and degenerative changes (67.2% vs 44.0%, P = .002) on their MRAs.

Conclusions

Rugby players undergoing surgical stabilization for glenohumeral instability often have a significant number of pathologies identified on MRA at the time of surgery. Professional rugby players showed concerningly greater frequencies of early degenerative changes when compared with nonprofessional rugby players.

Level of Evidence

III; Retrospective Cohort Study.

Shoulder functional status in rugby union players with and without history of shoulder problems

OBJECTIVES

To assess the effects of (1) rugby union practice, (2) history of injury managed nonoperatively, and (3) history of injury managed operatively on shoulder functional status in male rugby union players.

DESIGN

Cross sectional study.

SETTING

Clinical.

PARTICIPANTS

86 male athletes were assigned into four groups: multisport athletes, rugby union players without shoulder problems, with history of shoulder injury managed nonoperatively and with history of shoulder injury managed operatively.

MAIN OUTCOME MEASURES

SI-RSI questionnaire, maximal isometric glenohumeral internal and external rotator strength, unilateral seated shot put test, upper quarter Y balance test.

RESULTS

Healthy players presented higher internal (p = 0.03) and external (p = 0.04) rotator strength than multisport athletes. History of shoulder injury managed nonoperatively did not impair physical abilities but limited player's psychological readiness (p < 0.001). After 4.5-months, shoulder stabilization surgery impaired maximal muscle strength and upper quarter body stability and mobility (p < 0.001 for all).

CONCLUSIONS

The shoulder functional status in rugby union player presented increased glenohumeral rotator strength when compared to non-collision sport athletes. In rugby union players, psychological concerns remained in the long-term after a shoulder injury managed nonoperatively, and psychological and physical readiness seemed not be reached at 4.5 months postoperatively to respond to rugby union practice demand.