Acromioclavicular Joint Injuries in Professional Ice Hockey Players: Epidemiologic and MRI Findings and Association With Return to Play

Initial versus Subsequent Injury and Illness and Temporal Trends Among Professional Hockey Players

Background

Research is limited investigating injuries/illness incidence among National Hockey League (NHL) players. This study sought to establish injury/illness incidence, initial versus subsequent injury risk among NHL players, and determine temporal trends of injury and illness incidence.

Hypothesis

Variations in injury incidence by body region, and initial versus subsequent injury would be observed among positions.

Study Design

Retrospective cohort study.

Methods

Publicly available data were utilized. NHL players 18 years or older between 2007-2008 to 2018-2019 were included. Injury and illness was stratified by position and body segment. Incidence rate (IR), and initial versus subsequent injury and illness risk ratios were calculated. Temporal trends were reported.

Results

Nine thousand, seven-hundred and thirty four injuries and illnesses were recorded. Centers had the highest overall IR at 15.14 per 1000 athlete game exposures (AGEs) (95%CI:15.12-15.15) and were 1.4 times more likely to sustain a subsequent injury compared to other positions. The groin/hip/thigh was the most commonly injured body region with an IR of 1.14 per 1000 AGEs (95%CI:1.06-1.21), followed by the head/neck (0.72 per 1000 AGEs, 95%CI:0.66-0.78). Combined injury and illness IR peaked in 2009-2010 season at 12.01 (95%CI: 11.22-12.79). The groin/hip/thigh demonstrated peak incidence during the 2007-2008 season (2.53, 95%CI:2.17-2.90); head/neck demonstrated a peak incidence in 2010-2011 season (Overall: 1.03, 95%CI:0.81-1.26). Injuries reported as 'lower body' increased over time.

Conclusions

Positional differences were observed; centers demonstrated the highest overall IR, and subsequent injury risk. Injury by body region was similar to previous literature. Head/neck and concussion decreased over time supporting rule changes in body checking and visor wear. Clinicians should be aware that 'lower body' injuries increased over time; therefore, injuries to the groin/hip/thigh or knee are likely underreported.

Level of Evidence

Level 3.

Martial Arts: Orthopaedic Injuries and Related Biomechanics

Martial arts are various systems of combat skills encompassing striking and grappling. Many styles have evolved into modern sports, and some have been included in the Olympics. The physicality of these can predispose practitioners to musculoskeletal injuries, such as anterior cruciate ligament ruptures; patellar, shoulder, or elbow instabilities; extremity fractures; and hand and spine injuries, which have been studied both clinically and biomechanically. The most common injury related to longer time loss from participation is an anterior cruciate ligament rupture. Higher injury incidence is associated with a higher level of experience and competition. Orthopaedic management of martial arts injuries should reflect the specific needs of each martial artist and the biomechanics of motions common to each style. Full-contact practitioners may benefit from broader surgical indications and special attention to the choice and positioning of implants; nonsurgical treatment may be appropriate for certain pediatric or noncontact practitioners. Approximately 60% of martial artists can return to the preinjury level of participation after a major injury. Injury prevention and rehabilitation programs should optimize neuromotor control and core engagement to ensure proper body mechanics. Gradual incorporation of martial arts movement into the postoperative physical therapy curriculum can benefit physical progress and help gain confidence toward full participation.

Diagnosis and Nonoperative Treatment of Acromioclavicular Joint Injuries in Athletes and Guide for Return to Play

Injury to the acromioclavicular (AC) joint accounts for approximately 40% to 50% of all shoulder injuries. In contact sports, the prevalence of AC joint injury increases. This injury is frequently encountered and treated by fellowship-trained as well as general orthopedic surgeons. As such, it is important to understand the diagnostic and treatment pathways for AC joint disruption. The treatment pathways in athletes may be different from those in the general population. This article will focus on the diagnosis and nonoperative treatment of AC joint injuries in athletes. We will also comment on return-to-play guidelines after this nonoperative treatment.

Shoulder injuries in ice hockey players: Prevalence, common management, and return to play

Background

The sport of ice hockey has reached worldwide popularity, and it continues to grow. With this growth, however, there has also been an increase in the number of injuries related to the high-speed physical nature of the sport. Upper extremity related traumas and maladies are amongst the most commonly experienced injuries in this population of athletes. The objective of this narrative review is to appraise the current literary landscape as to the epidemiology, treatment, and return to play experienced with the most common upper extremity orthopedic injuries related to ice hockey play.

Methods

PubMed, Google Scholar, and OVID were searched individually using the filtered terms "shoulder", "injury", and "ice hockey". Articles that were published after 2000 were analyzed. Notably, the concepts of athlete sex, compete level, and post injury productivity were explored in detail.

Results

It is evident in the literature that upper extremity injury rates increased as level of play increased, were more common in males, and occurred more often during in-game situations. Acromioclavicular joint separations, shoulder instability, and clavicle fractures were amongst the most commonly cited ice hockey upper extremity injury presentations; acromioclavicular joint injuries were considered the most common upper extremity injury in ice hockey players. Return to play depends on injury type and severity. Overall, performance decreased upon initial return from injury.

Conclusion

Ultimately, further research needs to be conducted on shoulder related ice hockey injuries, their prevention, and the accurate management of specific presentations in order to ensure efficient and safe return to play.

Nonoperative Management of Traumatic Acromioclavicular Joint Injury: A Clinical Commentary with Clinical Practice Considerations

Traumatic injuries of the acromioclavicular joint result in pain and potentially long-term alterations in scapulohumeral rhythm that occurs due to disruption of the clavicular strut function which is integral to scapular kinematics. Nonoperative treatment remains a valid option in most acromioclavicular joint injuries with the potential of minimizing pain and restoring scapulohumeral rhythm. However, few studies have provided nonoperative treatment details. Therefore, the purpose of this clinical commentary is to discuss the rationale, indications, and techniques of nonoperative treatment and present an organized approach for evaluating and managing such patients based on the best available evidence. Attention will be focused on identifying the treatment methods employed and the results/outcomes of such treatments.

Level of Evidence

5.

Acromioclavicular joint instability on cross-body adduction view: the biomechanical effect of acromioclavicular and coracoclavicular ligaments sectioning

Background

The acromioclavicular (AC) and coracoclavicular (CC) ligaments are important stabilizers of the AC joint. We hypothesized that AC and trapezoid ligament injuries induce AC joint instability and that the clavicle can override the acromion on cross-body adduction view even in the absence of conoid ligament injury. Accordingly, we investigated how sectioning the AC and CC ligaments contribute to AC joint instability in the cross-body adduction position.

Methods

Six fresh-frozen cadaveric shoulders were used in this study, comprising five male and one female specimen, with a mean age of 68.7 (range, 51–87) years. The left side of the trunk and upper limb, and the cervical and thoracic vertebrae and sternum were firmly fixed with an external fixator. The displacement of the distal end of the clavicle relative to the acromion was measured using an electromagnetic tracking device. We simulated AC joint dislocation by the sequential resection of the AC ligament, AC joint capsule, and CC ligaments in the following order of stages. Stage 0: Intact AC and CC ligaments and acromioclavicular joint capsule; stage 1: Completely sectioned AC ligament, capsule and joint disc; stage 2: Sectioned trapezoid ligament; and stage 3: Sectioned conoid ligament. The superior clavicle displacement related to the acromion was measured in the horizontal adduction position, and clavicle overriding on the acromion was assessed radiologically at each stage. Data were analyzed using a one-way analysis of variance and post-hoc tests.

Results

Superior displacement was 0.3 mm at stage 1, 6.5 mm at stage 2, and 10.7 mm at stage 3. On the cross-body adduction view, there was no distal clavicle overriding at stages 0 and 1, and distal clavicle overriding was observed in five cases (5/6: 83%) at stage 2 and in six cases (6/6: 100%) at stage 3.

Conclusion

We found that AC and trapezoid ligament sectioning induced AC joint instability and that the clavicle could override the acromion on cross-body adduction view regardless of conoid ligament sectioning. The traumatic sections of the AC and trapezoid ligament may lead to high grade AC joint instability, and the distal clavicle may subsequently override the acromion.