The medical aspects of soccer injury epidemiology

Trends in Soccer-Related Craniomaxillofacial Injuries, United States 2003-2022

BACKGROUND

Soccer is one of the most popular sports worldwide. However, it has risks of injury to craniomaxillofacial regions such as the head, neck, and mouth.

PURPOSE

The purpose of this study is to determine which demographic and injury characteristics among soccer players with craniomaxillofacial injuries are associated with increased hospitalizations.

STUDY DESIGN, SETTING, AND SAMPLE

This is a retrospective cohort study utilizing the National Electronic Injury Surveillance System. Subjects included in this study experienced an injury to a craniomaxillofacial area from soccer between January 1, 2003, and December 31, 2022.

PREDICTOR VARIABLE

The predictor variables included demographics (age, sex, race) and injury characteristics (craniomaxillofacial region, diagnosis).

MAIN OUTCOME VARIABLE

The primary outcome variable was injury severity defined as hospitalization outcome after injury (yes/no). The secondary outcome variable was the trends in the incidence of soccer craniomaxillofacial injuries over time (2003-2022).

COVARIATES

The covariates were the heterogenous set of predictor variables in this study.

ANALYSES

Descriptive statistics and univariate analyses were computed. Survey-weighted univariate and multivariate logistic regression were used to measure the association of demographic and injury variables with hospitalization outcome. Statistical significance was defined as P < .05.

RESULTS

The study sample included 26,642 subjects (national estimate, 799,393). The national incidence of craniomaxillofacial soccer injuries generally increased between 2003 and 2012 and decreased between 2016 and 2020. Subjects in the ≥30 age group had increased odds of hospitalization compared to those in the 10-19 age group (odds ratio [OR], 2.12; P < .001). Compared to females, males had significantly higher odds of hospitalization (OR, 1.53; P < .001). Head (OR, 8.42; P < .001) and neck (OR, 15.8; P < .001) injuries had increased odds of hospitalization compared to facial injuries. Relative to contusions/abrasions, subjects with fractures (OR, 94.7; P < .001), dental injuries (OR, 41.3; P < .001), and concussions (OR, 5.33; P = .017) were at significantly higher odds of hospitalization.

CONCLUSION AND RELEVANCE

Age, sex, craniomaxillofacial region, and diagnosis were significant predictors of hospitalization outcome after craniomaxillofacial soccer injury. Safer playing styles, use of mouthguards, and proper medical management may reduce future risks of craniomaxillofacial injury from soccer.

Change of Direction Speed and Reactive Agility in Prediction of Injury in Football; Prospective Analysis over One Half-Season

Agility is an important factor in football (soccer), but studies have rarely examined the influences of different agility components on the likelihood of being injured in football. This study aimed to prospectively evaluate the possible influences of sporting factors, i.e., flexibility, reactive agility (RAG), and change of direction speed (CODS), on injury occurrence over one competitive half-season, in professional football players. Participants were 129 football professional players (all males, 24.4 ± 4.7 years), who underwent anthropometrics, flexibility, and RAG and CODS (both evaluated on non-dominant and dominant side) at the beginning of second half-season 2019/20 (predictors). Over the following half-season, occurrence of injury was registered (outcome). To identify the differences between groups based on injury occurrence, t-test was used. Univariate and multivariate logistic regressions were calculated to identify the associations between predictors and outcome. Results showed incidence of 1.3 injuries per 1000 h of training/game per player, with higher likelihood for injury occurrence during game than during training (Odds Ratio (OR) = 3.1, 95%CI: 1.63–5.88) Univariate logistic regression showed significant associations between players’ age (OR = 1.65, 95%CI: 1.25–2.22), playing time (OR = 2.01, 95%CI: 1.560–2.58), and RAG (OR = 1.21, 95%CI: 1.09–1.35, and OR = 1.18, 95%CI: 1.04–1.33 for RAG on dominant- and non-dominant side, respectively), and injury occurrence. The multivariate logistic regression model identified higher risk for injury in those players with longer playing times (OR = 1.81, 95%CI: 1.55–2.11), and poorer results for RAG for the non-dominant side (OR = 1.15, 95%CI: 1.02–1.28). To target those players who are more at risk of injury, special attention should be paid to players who are more involved in games, and those who with poorer RAG. Development of RAG on the non-dominant side should be beneficial for reducing the risk of injury in this sport.

The lack of standardized outcome measures following lower extremity injury in elite soccer: a systematic review

PURPOSE

Sport-specific, performance-based outcomes are increasingly used to improve evaluation of treatment efficacy in elite athletes; however, its usage in elite soccer may be limited. The purpose of this investigation is to (1) assess current outcome reporting in elite soccer; (2) identify any variability in reporting of outcomes; and (3) determine how sport-specific performance-based outcomes are utilized to assess treatment efficacy in elite soccer.

METHODS

A systematic review of the Pubmed, MEDLINE, and Embase, Scopus, SportDiscus, CINAHL and HealthSource: Nursing databases was performed without limitation on publication year. Inclusion criteria were (1) reporting of outcomes after a (2) lower extremity injury in (3) elite soccer players. The study's population, type of injury, return to play, as well as functional, objective, and sport-specific performance-based outcomes were extracted from each article. The methodological index for nonrandomized studies was used for quality assessment.

RESULTS

Twenty-one studies were selected after application of the inclusion and exclusion criteria. Objective outcomes were reported by 6 (29%) studies, and 6 (29%) employed patient-reported outcomes. The visual analog scale, Lysholm, and Tegner scores were the most common patient-reported outcomes (PROs). Return to play was reported by 18 (86%) studies, and only 2 (10%) utilized sport-specific performance-based outcomes. Despite the majority of studies reporting return to play, variation was seen in the definitions, and 15 (71%) studies reported the activity level of the players at final follow-up.

CONCLUSION

Assessment of treatment efficacy is limited in elite athletes, and PROs lack the sensitivity to identify residual performance deficits after an injury. Although performance-based measures are available at the elite level, these outcomes were seldom used for evaluation of treatment efficacy.

CLINICAL RELEVANCE

When treating elite soccer players, patient-reported outcome measures lack the sensitivity to detect changes in patient function, thus performance-based metrics may be more efficacious in assessing return from injury in these patients.

LEVEL OF EVIDENCE

IV.

Osteoarthritis of the hip and knee in former male professional soccer players

BACKGROUND

Professional soccer (PS) players are at great risk of osteoarthritis (OA) of the knee and hip.

SOURCES OF DATA

Following the PRISMA guidelines, the key words 'osteoarthritis' and 'soccer' or 'football' were matched with 'players' or 'former' or 'retired' and with 'hip' or 'knee' on December 24, 2017 in the following databases: PubMed, Cochrane, Google scholar, Embase and Ovid. Only comparative studies reporting the prevalence rate of OA of both hip and knee joint in former PS athletes (fPSa) and age and sex matched controls were considered.

AREAS OF AGREEMENT

In fPSa, the prevalence rate of OA of both hip and knee is significantly higher compared to age and sex matched controls.

AREAS OF CONTROVERSY

The pathological pathways responsible for the development of OA of the hip and knee in PS athletes (PSa) are still not clearly understood.

GROWING POINTS

The prevalence rate of clinical OA of the hip was 8.6% in fPSa and 5.6% in controls (odd ratio (OR) = 1.5; 95% CI: 1.06-2.31). The radiographic rate of OA was 21.2% in fPSa and 9.8% in controls (OR = 2.4; 95% CI: 1.66-3.69). A total of 14.6 and 53.7% of fPSa presented clinical and radiographic signs of OA of the knee, respectively, vs 12.9% (OR = 1.16; 95% CI: 0.86-1.55) and 31.9% (OR = 2.47; 95% CI: 2.03-3.00) of controls. Sonographic evidence of OA of the knee was found in 52% of fPSa and 33% of controls (OR = 2.2; 95% CI: 1.24-3.89).

AREAS TIMELY FOR DEVELOPING RESEARCH

Preventive training programmes should be developed to reduce the number of fPSa presenting early OA.

From sports injury prevention to safety promotion in sports

Every fifth unintentional injury treated at a healthcare facility in the industrialised part of the world is associated with sports or physical exercise. This article reviews the literature regarding the theoretical and practical underpinnings for community-based sports safety promotion, including both professional and recreational sports. While injury prevention entails the implementation of specific interventions in terms of structural or educational measures, sports safety promotion includes also the antecedent and wider campaigns that are required to succeed with these measures. Comprehensive sports safety promotion programmes thus require that the perspective on the sports injury problem is made broader than consideration of the individual athlete. The results display that involvement in sports safety issues from the sports federations that formulate policies and allocate resources is necessary for coordinated implementation of programme actions. The authorities responsible for sports facilities and legislations in the civil society also need to be included, because of the fact that they control many of the central safety determinants in the sporting environment. It is concluded that the sports injury problem needs to be addressed in liaison with the leaders of socially defined sports communities and the governments representing geographically defined civic communities, and that the safety-supporting environment in professional sports is underdeveloped compared with other areas of working life.

Risk for injury when playing in a national football team

The Swedish male senior national football team was followed prospectively between 1991 and 1997. During these 6 years, the team played 73 official matches and had three training camps. The senior author (J. E.) attended 57 of these matches and the three training camps and these matches and training camps, are included in the present study. Exposure to football was recorded individually for each player. The team physician examined all injuries. Total exposure was 7245 h (6235 training and 1010 match hours) and there were 71 injuries (40 training and 31 match injuries). Five (16%) of the match injuries were major, with more than 4 weeks of absence from football. The injury incidence during training was 6.5/1000 h and the injury risk during matchplay was 30.3/1000 h. A significantly higher injury incidence was found for matches lost compared to matches won or drawn (52.5 vs. 22.7/1000 h, P=0.026). No statistically significant difference for injury was found between competitive matches and friendly matches. No difference was found between home and away matches or matches on neutral ground. The risk for injury when playing in a national team compares with previously reported figures for professional football at a high level.

Injuries in competitive junior ice-hockey. 1437 players followed for one season

During one season we followed 1437 ice-hockey players, 9-18 years of age, participating in a junior league. We found 128 injuries (9 percent) that caused the player to miss at least one training session or game. One third of the injuries were a result of foul play. The most common types of injury were contusions, sprains, and lacerations. However, fissures and fractures were surprisingly frequent, reflecting foul play with the stick and improper use of the protective equipment. Thanks to the mandatory use of a completely-covering face protector, there were few maxillofacial injuries. The highest yearly incidence of injuries was found in the older players. Prevention of ice hockey injuries is multifactorial, including stricter rule enforcement, improved protective equipment, and better understanding of the forces involved.

Incidence and nature of sports injuries in Ireland. Analysis of four types of sport

The objectives of this study were to investigate the incidence of sports injuries in Ireland and to analyze various ways of quantifying the seriousness of these injuries. A 12-month, prospective study was carried out on 324 Irish athletes involved at a high level of sports participation in one of the following categories: endurance, contact, noncontact, or explosive sports. Results were expressed in four ways: 1) number of injuries per year; 2) days injured per year; 3) number of injuries per 10,000 hours of participation; and 4) duration of injury per 1000 hours of participation. The average athlete sustained 1.17 acute and 0.93 overuse injuries per year and suffered the effects of sports injury for 52 days. More time was lost through overuse injuries than acute injuries. The incidence of acute injuries per 10,000 hours of participation was lowest in the noncontact sports and highest in the contact sports, but there was no difference in the incidence of overuse injuries between any of the four categories of sport. The injury rate per 10,000 hours of participation was lowest in noncontact and explosive sports and highest in contact sports. However, when expressed in terms of days lost per 1000 hours of participation, endurance sports had the lowest incidence of time loss and explosive sports the highest.