Sports injuries patterns in children and adolescents according to their sports participation level, age and maturation

Imaging of sports injuries in adolescents

Musculoskeletal injuries in adolescents tend to occur in particular locations and have distinct characteristics, as they affect an immature skeleton. Increased engagement in sports, extended training and competition periods, and early specialization in specific sports, among other factors, have contributed significantly to the rise in musculoskeletal sports injuries in adolescents. Furthermore, females show a particularly pronounced increase in sports participation, where anatomical and hormonal factors play crucial roles in the development and increased frequency of sports-related injuries. Consequently, there is a growing demand for diagnostic imaging techniques. Musculoskeletal and pediatric radiologists require a comprehensive understanding of intrinsic and extrinsic risk factors and the successive stages of skeletal development that can influence the specific characteristics of sports injuries in adolescents. These aspects are crucial for the diagnostic, prognostic, and therapeutic management of these injuries and for mitigating chronic conditions that could compromise future sports participation. This review analyzes the primary musculoskeletal injuries in adolescent athletes and highlights the pivotal role of different imaging methods in their diagnosis and management.

Sex- and Age-Specific Review of Flag Football Injuries in the United States: A 10-Year Analysis of National Injury Data

CONTEXT

Flag football is a rapidly growing sport with injuries frequently presenting to emergency departments (EDs). Current literature on flag football lacks mechanisms of injury and any information pertaining to female athletes. The purpose of this study was to examine demographic-specific injury trends in those playing flag football.

EVIDENCE ACQUISITION

The National Electronic Injury Surveillance System (NEISS) was queried for flag football injuries presenting to United States EDs from January 1, 2013 to December 31, 2022. Patient demographics, injury site, diagnosis, and disposition were recorded. NEISS narratives were used to identify mechanisms of injury. National estimates (NEs) were calculated using the NEISS statistical sample weight. Annual injury trends were evaluated by linear regression.

STUDY DESIGN

Descriptive epidemiology study.

LEVEL OF EVIDENCE

Level 3.

RESULTS

There were 2508 flag football injuries (NE, 86,443) analyzed from 2013 to 2022; 78.2% were sustained by male athletes. Linear regression analysis revealed no significant trend in annual injuries (P = 0.16) from 2013 to 2022. The most common mechanism of injury was player-player collision (35.7%). The 2 age groups most affected by flag football injuries were middle school-aged (11-13 years) (20.8%) and high school-aged (14-18 years) (23.7%). The area of the body most affected for pediatric (<18 years) groups was the head, while adults most frequently injured their fingers. In addition, the most common mechanism for the pediatric age group was fracture (21.3%), whereas adult age groups most frequently suffered from strain/sprain injuries.

CONCLUSION

The number of injuries from flag football identified in this study has not decreased throughout the last decade, aside from 2020 - potentially due to the prevalence of COVID-19. Collisions were the most frequent mechanism of injury across all age groups. Whereas younger athletes frequently sustained head injuries and fractures, older athletes typically sustained strain/sprain injuries and finger injuries.

Effect of virtual reality therapy on pain relief in sports rehabilitation for young adults: A systematic review and meta-analysis

BACKGROUND

Virtual reality is an emerging technology that intends to promote motor and perceptual-cognitive skills, which could benefit people with sports injuries. However, there is a lack of meta-analyses on its effectiveness in sports injury rehabilitation for young adults.

OBJECTIVE

This systematic review and meta-analysis of randomised controlled trials evaluated the effectiveness of virtual reality therapy (VRT) on sports-related musculoskeletal rehabilitation in reducing pain and improving functional levels and balance among young adults.

METHODS

Studies and relevant reviews were searched using PubMed, CINAHL, EMBASE, CENTRAL, Web of Science, Scopus, grey literature in Google Scholar, ProQuest Dissertation and Theses, and manual searching of reference lists. Studies published up to 19 March 2024 involving young adults aged 18-40 with sports-related injuries undergoing VRT were included. The comparator was conventional rehabilitation. Meta-analysis was done by pooling standardised mean differences (SMD) or mean differences (MD) of pain, functional levels, and balance outcomes using the random-effects model. Quality appraisal was done using the Cochrane Risk of Bias Tool and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).

RESULTS

Eleven studies (n = 507 participants) were included. VRT seems significantly superior to conventional therapy in improving pain post-intervention (pooled SMD -5.16, 95% CI -7.36 to -2.97) and at long-term follow-up (pooled SMD -10.08, 95% CI -12.46 to -8.01). However, outcomes for functional levels and balance measured using the Star Excursion Balance Test were non-significant. Five trials had a low risk of bias, 3 were at high risk, and 3 had an unclear risk of bias. Outcomes were of very low to low certainty.

CONCLUSION

VRT seems able to significantly improve pain among young adults with sports-related musculoskeletal injuries. Therapists and clinicians can consider incorporating VRT in rehabilitation to engage participants and improve outcomes. Limited research has investigated the effect of VRT on function and balance.

Are Elbow Osteochondritis Dissecans Lesions Different for Gymnasts and Baseball Players?

OBJECTIVE

Gymnasts and baseball players have different mechanisms of loading their elbows, and there is little data comparing osteochondritis dissecans (OCD) lesions between these 2 sports. Our objective is to compare the clinical and imaging characteristics of elbow OCD lesions between weight-bearing and throwing athletes.

DESIGN

Review from 2015 to 2022.

SETTING

Sports medicine clinics at a large academic center.

PATIENTS

Thirty-four patients were included.

INDEPENDENT VARIABLES

Patients were divided into 2 groups: gymnastics and baseball.

MAIN OUTCOME MEASURES

Location of elbow OCD lesion on the capitellum, stability of lesion, lesion size, and the presence of a radial head deformity.

RESULTS

Twenty-two (65%) baseball players and 12 (35%) gymnasts were included with 97% (33/34) of athletes presenting with a capitellar lesion. Seventy-six percent of athletes had a radial head deformity with no difference in frequency between groups ( P = 0.61). There was also no difference in frequency of lesion instability ( P = 0.56) or lesion size. Baseball players had a higher frequency of lesions located anteriorly on the capitellum compared with gymnasts (28% vs 0%, P = 0.02), and gymnasts had a higher frequency of lesions located centrally (24% vs 58%, P = 0.02). Gymnasts had significantly different presenting symptoms ( P = 0.03) with a higher frequency of isolated pain.

CONCLUSIONS

There are no significant differences in the size, stability, or location of OCD lesions in weight-bearing and throwing athletes. The presence of an associated radial head deformity was seen on most radiographs without any difference between sport. Lesion location and symptoms at presentation are significantly different between gymnastics and baseball.

LEVEL OF EVIDENCE

III.

Neighborhood Disadvantage and Injury Mechanism, Severity, and Outcomes in Pediatric Trauma

BACKGROUND

Traumatic injuries remain the leading cause of death in children aged 1-14. Previous research demonstrates a link between lower socioeconomic status (SES) and higher pediatric injury morbidity and mortality. There is scant research exploring the relationship between neighborhood disadvantage and pediatric trauma. This study utilizes Area Deprivation Index (ADI) to understand the relationship between pediatric traumatic injury mechanisms, severity, and outcomes and neighborhood disadvantage.

METHODS

We performed a single-center cross-sectional analysis of pediatric trauma patients aged 0-18 presenting to our Level 1 Pediatric Trauma Center from 2016 to 2021. Patients were stratified into quintiles by national ADI. Injury mechanisms and severity markers were analyzed across ADI quintiles. A subset analysis was also performed, comparing complications and outcomes across ADI quintiles for severely injured patients.

RESULTS

Children from areas of higher disadvantage experienced higher rates of injuries related to automobiles, non-accidental trauma (NAT)/assault/neglect, penetrating injuries, and thermal injuries (p < 0.001). Children from areas of low disadvantage incurred more injuries related to sports (p < 0.001) and falls (p = 0.002). Multiple markers of trauma severity increased with increasing neighborhood disadvantage. No differences were found in clinical outcomes in the subset of most severely injured children.

CONCLUSIONS

Mechanisms and severity of traumatic injuries among children vary with degree of neighborhood disadvantage. Outcomes did not differ by ADI quintile in the most severely injured children. ADI may be a tool for identifying children at higher risk for certain injury mechanisms and more severe injuries and could be used to target injury prevention interventions to more vulnerable communities.

TYPE OF STUDY

Retrospective cross-sectional analysis.

LEVEL OF EVIDENCE

Level IV.

Decreasing Incidence of Youth Wrestling Injuries: A 10-Year Analysis of National Injury Data

Background

Wrestling is among the most common youth sports in the United States, with about 260,000 high school participants annually. There is a lack of literature investigating wrestling injury profiles and mechanisms of injuries. In the past 15 years, urgent care utilization has increased, and National Federation of State High School Associations (NFHS) concussion protocols have been developed and implemented.

Purpose/Hypothesis

The purpose of this study was to analyze causes, diagnoses, body parts, and trends associated with wrestling injuries presenting to US emergency departments. It was hypothesized that there would be (1) decreased overall injuries presenting to emergency departments because of increased urgent care utilization and (2) decreased concussions because of the NFHS rule implementation and revision.

Study Design

Descriptive epidemiology study; Level of evidence, 3.

Methods

Youth wrestling injuries presenting to US emergency departments between January 1, 2013, and December 31, 2022, were queried from the National Electronic Injury Surveillance System database. The data included date of presentation, age, sex, race, body part, injury diagnosis, disposition, and a brief injury narrative. National estimates (NE) were calculated using the associated statistical weight of the reporting hospital. Linear regressions were performed to investigate the relationship between year and NE for overall injuries, diagnoses, body parts, mechanisms of injury, and other subanalyses. Statistical significance was set at P < .05.

Results

A total of 8628 (NE = 296,502) wrestling injuries met the inclusion criteria for this study. The mean age at presentation was 14.3 ± 2.6 years (range, 3 to 18 years). The shoulder (NE = 43,207 [14.6%]), head (NE = 40,875 [13.8%]), and knee (NE = 30,218 [10.2%]) were the most injured body parts. The most common diagnoses were strain/sprain (NE = 91,924 [31%]), other/not stated (NE = 53,736 [18.1%]), and fracture (NE = 52,261 [17.6%]). Common mechanisms of injury included not specified (NE = 148,169 [50%]), impact with mat (NE = 61,557 [20.8%]), and abnormal rotation/strain (NE = 37,449 [12.6%]). Overall injuries (P = .01) (coefficient: -1763 [95% CI, -2963 to -563]) and concussions (P = .01) (coefficient: -178 [95% CI, -302 to -55]) statistically significantly decreased.

Conclusions

Our study showed a trend in the decrease in overall injuries and concussions in high school wrestlers. Strains/sprains were the most common diagnoses with the shoulder being the most common site. Youth wrestlers would benefit from future research analyzing risks associated with these injuries as well as advances in protective gear.

Adolescents' experience with sports-related pain and injury: A systematic review of qualitative research

OBJECTIVE

The aim of this review is to synthesise qualitative studies examining adolescents' experience with pain and injury arising from sports participation.

METHODS

This review was registered on Open Science Framework prior to data extraction. A systematic search of PubMed, Embase, and SPORTDiscus was conducted. Studies were appraised using the CASP (critical appraisal skills programme) checklist. Data was synthesised using a meta aggregation.

STUDY SELECTION CRITERIA

Inclusion criteria included studies related to adolescents aged 14-19yrs with sports related pain/injury, employed a qualitative design, full text publications in English.

RESULTS

Sixteen studies of 216 participants were included. Studies investigated severe knee injuries, concussion, or other musculoskeletal injuries. Synthesised findings show that, regardless of injury type, adolescents experience a mix of positive (motivation to rehab and return to sport, optimism) and negative emotions (fear of re-injury, isolation, depressive responses) throughout recovery. Common coping strategies were to ignore symptoms, modify activity levels, or seek support.

CONCLUSION

Sports-related pain and injury has a multifaceted effect on the adolescent athlete. There is a pervasive fear of re-injury and social isolation, but the desire to return to sports is facilitated through motivation and support. Peer motivation effects the willingness of the adolescent to persist with rehabilitation.

Knowledge, attitudes, practice, and public health education demand regarding PARI prevention: a cross-sectional study among Chinese undergraduates

OBJECTIVES

The purpose of this study was to assess the level of knowledge, attitudes, and practices (KAP) of university students in China regarding the need for PARI and public health education.

METHODS

A cross-sectional online and offline survey was conducted in China website through Wenjuanxing and in different cities such as Changsha Hunan Province, Shanghai, Chongqing and in different public scenarios, such as hospitals, universities, and commercial venues between September 1 and September 7, 2023, using a 28-question questionnaire designed and reviewed by multidisciplinary experts.

RESULTS

A total of 4,096 respondents were recruited for this study, with 3,957 valid questionnaires. The mean knowledge score was 1.84 ± 0.52, the mean attitude score was 2.12 ± 0.51, and the mean practice score was 3.18 ± 0.55. Regression analyses found that: region, grade, school, and weekly anaerobic exercise time were influences on the knowledge score; region, grade, school, and weekly anaerobic exercise time were influences on the attitude score; region, grade, school attended, weekly anaerobic exercise time and weekly anaerobic exercise time as influences on the practice score. Subgroup analyses revealed that undergraduates from southern regions and 985 schools had higher knowledge attitude scores and lower practice scores. As the grade level increased, the knowledge and attitude scores showed a V-shaped trend and the behavior scores showed an inverted V-shaped trend. Correlation analysis found a positive correlation between knowledge and attitude scores, and a negative correlation between both and behavior, respectively. The public health education needs survey found that undergraduate students generally preferred guided instruction methods and content centered on the RICE principles, they preferred learning through books and pamphlets, and they were happy to see relevant content promoted in the campus environment.

CONCLUSION

This study shows that Chinese undergraduate students have less knowledge, neutral attitudes, and good behaviors regarding PARI prevention. Special attention should be paid to meeting the needs of undergraduate students for public health education to equip them with relevant knowledge so that they can better behave in PARI prevention.

Sleep characteristics and adolescent physical activity-related injuries in sports clubs, leisure time and schools

OBJECTIVE

Sleep has been identified as an important factor in relation to physical activity-related injury (PARI) in adolescents. The study aimed to explore associations between sleep duration, sleep problems and PARI among Slovak adolescents in three different settings: sports clubs, leisure time and schools.

METHODS

We analysed data from the cross-sectional Health Behaviour in School-aged Children study conducted in 2022 on a representative sample of 10 163 Slovak adolescents aged from 10.5 to 18.3 (mean age 13.4 (SD=1.5); 50.9% boys). Data were collected through self-administered online questionnaires completed by respondents in schools during the classes. Multiple logistic regression models were used to assess associations between sleep duration during schooldays and weekends, sleep problems and PARI in sports clubs, leisure time and schools.

RESULTS

Adolescents with normal sleep duration during schooldays and those who reported no problems with falling asleep, waking up at night and day sleepiness had a higher chance of not being injured during PA in sports clubs, leisure time and schools compared with adolescents with short sleep duration and sleep problems. Sufficient sleep duration during the weekend increased the probability of not having PARI in leisure time and schools, with the strongest association between long sleep duration and PARI in leisure time.

CONCLUSION

Good sleep quality and sufficient sleep duration were found to play a protective role in relation to PARI in adolescents. The findings suggest implementing sleep interventions in PARI prevention programmes, which must be considered a key component of adolescent PA promotion.

Biomechanical Factors Predisposing to Knee Injuries in Junior Female Basketball Players

This cross-sectional observational study aims to determine isokinetic normality data at different speeds, and isometric data of ankle and knee joints, in healthy basketball players aged 15-16 years old. The participants were recruited through non-probabilistic convenience sampling. Sociodemographic, anthropometric, and biomechanical variables were collected. The study involved 42 participants. Right-leg dominance was higher in women (85.7%) than in men (78.6%). Men had a higher weight, height, and body mass index compared to women. Statistically significant differences were observed between sex and height (p < 0.001). Significant differences were found between sexes in knee flexor and extensor strength at different isokinetic speeds (30°, 120°, and 180°/s), except for the maximum peak strength knee flexion at 180°/s in the right leg. In the ankle, the variables inversion, eversion, and work strength values at different isokinetic speeds and full RoM, by sex, were not significantly different, except for the right (p = 0.004) and the left (p = 0.035) ankle full RoM. The study found lower knee extensor strength in women, indicating the need to improve knee flexor/extensor strength in women to match that of men, as seen in other joints. The results can guide the development of preventive and therapeutic interventions for lower limb injuries in basketball players.

Higher Sedentary Behaviors and Lower Levels of Specific Knowledge Are Risk Factors for Physical Activity-Related Injuries in Saudi Adolescents

Encouraging physical activity (PA) for adolescents is necessary to achieve and maintain optimal health, but it may increase the risk of PA-related injuries. This study sought to assess the frequency, location, type, and severity of PA-related injuries in Saudi students aged 13 to 18 years and to identify associated risk factors. A total of 402 students, including 206 boys aged 15.87 ± 1.69 years and 196 girls aged 15.83 ± 1.70 years, were randomly assigned to participate in this study. For each participant, height, weight, body mass index, and fat percentage were measured. Responses to a specially designed four-part self-administered questionnaire were also collected. Results revealed that better specific knowledge was associated with a lower likelihood of sustaining injuries (β = -0.136; p = 0.001) but increased sedentary behaviors were associated with a greater likelihood of sustaining a PA-related injury (β = 0.358; p = 0.023). Gender, knowledge, and sedentary behaviors were the factors overall associated with a greater likelihood of suffering 1, 2, and 3 or more PA-related injuries. However, gender, fat-free mass, knowledge, and sedentary behaviors were associated overall with a greater likelihood of bruises, strains, fractures, sprains, concussions, and at least two types of PA-related injuries. Collectively, we should pay attention to the PA-related injury problem among middle and high school students, particularly when promoting a physically active lifestyle.