New Recommendations on Sport-Related Concussions: Stronger Methodology, Practical Messages, and Remaining Challenges No abstract available

Relative Head Impact Exposure and Brain White Matter Alterations After a Single Season of Competitive Football: A Pilot Comparison of Youth Versus High School Football Objective: Youth athletes are believed to be more susceptible to white matter (WM) degradation resulting from head impact exposure relative to high school (HS) athletes; this hypothesis has not been objectively tested. The purpose of this study was to determine preseason to postseason changes in WM integrity from repetitive head impacts for youth football (YFB) players compared with HS football players during a competitive football season. Design: Prospective cohort. Setting: One season of YFB (grades 7 and 8) and varsity HS football (grades 10-12). Patients or Other Participants: Twelve YFB (13.08 ± 0.64 years) and 21 HS (17.5 ± 0.78 years) athletes. Interventions: Participants completed 2 magnetic resonance imaging sessions: preseason and postseason. Head impact exposure was recorded during practice and games using a helmet-mounted accelerometer. Main Outcome Measures: Tract-based spatial statistics were used to evaluate group differences in preseason to postseason changes in diffusion tensor imaging, including fractional anisotropy and mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). Results: The HS group exhibited significant preseason to postseason reductions in MD, AD, and RD (P < 0.05, corrected) in widespread WM areas. Significant WM reductions for the YFB group were only observed for AD (P < 0.05, corrected), but was more limited in extent compared with HS. Conclusions: Significant preseason to postseason AD reduction was found in both YFB and HS groups after one season of competitive play. Our results did not confirm recent speculation that younger children are more susceptible to the deleterious effects of repetitive head impacts compared with their older counterparts.

Return to Sport After Short-Stem Total Hip Arthroplasty Objectives: Information about sport activity after short-stem total hip arthroplasty (THA) is scarce in the literature. We therefore aimed to evaluate the rate of return to sport after short-stem THA. Methods: We evaluated the sport pattern, rate of return to sport, activity level, extent of sport activity, and subjective rating and sense of well-being in 137 patients (137 hips) after short-stem THA. The minimum follow-up time was 18 months. All results were analyzed according to gender (male and female) and age (≤60, >60-≤70, and >70 years). Results: Ninety-two percent of all patients practiced sport before surgery, and 91% of the patients returned to sport. Most patients returned to sport within the first 6 months after surgery. There was a decline in the number of sport disciplines from preoperatively to postoperatively, which was from 2.9 to 2.6 (P = 0.025). High-impact activities decreased postoperatively, but most low-impact activities did not change significantly. Eighty percent of all patients were involved in recreational sports. Conclusion: In this study, we observed an excellent rate of return to sport after short-stem THA. Most patients returned to the same level of sport activity that they had before the onset of restricting symptoms, with the majority of patients having a great sense of well-being during and after sports, and almost no pain in the affected hip.

Impact of Clavicle Fractures on Return to Play and Performance Ratings in NFL Athletes Objective: Clavicle fractures in the National Football League (NFL) have gained significant attention because of their impact on high profile athletes; however, little has been published on the overall impact of these injuries. This study sought to determine the time to return to play and quantitative impact on athletic performance after clavicle fractures in NFL athletes. Design: Retrospective Cohort Study; Level of evidence, 3. Setting: Retrospective cohort study of NFL athletes based on published injury reports and player statistics. Participants: This study consisted of 17 NFL athletes who sustained a clavicle fracture from 1998 to 2015 and returned to the field after the injury during the study period. Three athletes were excluded from performance analysis because of not playing for the entire season after injury. Control groups consisted of position-matched NFL athletes who competed in the 2013 NFL season without an identified clavicle injury. Main Outcome Measures: Median time to return to play after a clavicle fracture and the impact on player performance rating. Results: Athletes returned to the competition after a median of 3.47 months after injury and missed a median of 8 games. There was no statistically significant impact on athletic performance after returning to play. Conclusion: Although clavicle fractures did have a significant impact on athletes because of lost playing time, there was no statistically significant difference in player performance after the injury when compared with a control group.

Displaced Clavicle Fractures in Cyclists: Return to Athletic Activity After Anteroinferior Plate Fixation Background: One of the most commonly observed injuries in cycling is fracture of the clavicle. Nevertheless, there is limited literature available on clinical outcomes after plate fixation of clavicle fractures in cyclists, rehabilitation protocols, and the time to return to sports. Purpose: The aim of this study was to evaluate the functional outcome, complications, and return to athletic activity at short-term follow-up after surgical repair. Study Design: Case series. Methods: Between January 2008 and October 2014, all professional and recreational cyclists presenting with a new clavicle fracture at the emergency department were prospectively recorded. All patients had an anteroinferior plate fixation, variable angle locking compression plate (DePuySynthes). Patients were seen at 2, 6, and 24 weeks at the outpatient clinic to gather Disability of the Arm, Shoulder, and Hand (DASH) and Constant shoulder questionnaires and radiographs were made. Cyclists were allowed to resume outside training 1 week after surgery. Results: Ten professional cyclists and 15 recreational cyclists were included. All (25/25) patients returned to cycling after plate fixation. Mean Constant scores and mean DASH scores of 96.8 ± 4.1 and 5.1 ± 5.5 at 6 weeks and 99.1 ± 1.5 and 2.9 ± 4.6 at 24 weeks were measured. There were 3 complications: 1 patient developed a nonunion, there was 1 wound infection requiring antibiotics, and in 1 patient, a refracture occurred. Conclusion: Plate fixation for cyclists with displaced clavicle fractures was successful in terms of fast return to previous level of athletic activity. It is a valuable and safe option for athletes in cycling.

Return to Sport After Arthroscopic Autologous Matrix-Induced Chondrogenesis for Patients With Osteochondral Lesion of the Talus Objective: To determine the rate of return of patients to sport after arthroscopic autologous matrix-induced chondrogenesis (AT-AMIC) for outcomes 2 years after surgery. Design: Retrospective observational cross-sectional study. Setting: C.A.S.C.O.—Foot and Ankle Unit, Istituto Ortopedico Galeazzi, Milan, Italy. Patients and Intervention: Twenty-six consecutive patients, 65.4% male (mean ± SD age: 33.7 ± 11.0 years), that underwent AT-AMIC procedure between 2012 and 2015 were selected retrospectively. From this population, only sporting patients at amateur's level were included. Arthroscopic autologous matrix-induced chondrogenesis was proposed in patients with pain and persistent disability. Main Outcome Measures: All patients were assessed with the American Orthopaedic Foot and Ankle Score (AOFAS), physical component score of the 12-Item Short Form Health Survey (SF-12), Halasi ankle activity score, and University of California, Los Angeles (UCLA) activity scale preoperatively and at 24 months postoperatively. Results: Overall, 80.8% of the patient group returned to the same preinjury sport. The mean follow-up was 42.6 ± 10.9 months (range from 25 to 62 months). Significant differences were observed with reference to AOFAS, SF-12, Halasi, and UCLA scores at the last follow-up in patients who had undergone AT-AMIC (all, P < 0.001). Conclusions: A high percentage of patients return to their preinjury sport after AT-AMIC surgery.

Long-Term Outcome of Mini-Open Surgical Decompression for Chronic Exertional Compartment Syndrome of the Forearm in Professional Motorcycling Riders Objective: To evaluate results of mini-open fasciotomy (MOF) in high-level motorcycling or motocross riders with chronic exertional compartment syndrome (CECS) at long-term follow-up (minimum 5 years). Design: Case series. Level of evidence: IV. Setting: University Hospital/Private Practice. Patients: Fifty-four professional motorcycling riders treated with MOF for a CECS of the forearm from January 2006 to June 2011. Inclusion criteria comprised: high-level motorcycling or motocross riders, clinical symptoms of CECS for at least 6 months, diagnosis confirmed using preoperative compartment hydrostatic pressure measurement and/or magnetic resonance imaging of the forearm, minimum follow-up of 5 years. Interventions: A MOF to obtain decompression of all compartments was performed in all patients. Main Outcome Measures: Visual analog scale; a subjective scale to measure strength; QuickDash functional scores. Time to resume full riding capacities as short-term evaluation. Results: A total of 54 patients who underwent 77 MOF procedures overall (23 bilateral) were included. The mean age was 23.6 ± 5.2 years. Mean Visual Analog Scale decreased from a preoperative value of 68.2 to a 3-month postoperative value of 26 (P < 0.001). Mean QuickDash scale was 84 at preoperative registration, falling to 20, 3 months after surgery (P < 0.001) and down to 12 at 1-year follow-up (P = 0.017). The average time to return to full riding capacities was 3.5 ± 1 week. Conclusions: Mini-open fasciotomy resulted safe and effective for the treatment of chronic exertional compartment syndrome in high-level motorcycling or motocross riders. The good outcome at follow-up resulted stable at 5 years and the incidence of complications remained low. Our data demonstrate that the resolution of symptoms is reliable and durable. Pain recovery was immediate after surgery, instead functional scores showed a more gradual recovery throughout the 12 months after surgery. Clinical Relevance: Mini-open fasciotomy is a reliable treatment for CECS of the forearm in professional motorcycling riders. This treatment should also be considered in young riders due to the absence of tardive relapse reported in this study.

Impact of CrossFit-Related Spinal Injuries Introduction: Exercise-related injuries (ERIs) are a common cause of nonfatal emergency department and hospital visits. CrossFit is a high-intensity workout regimen whose popularity has grown rapidly. However, ERIs due to CrossFit remained under investigated. Methods: All patients who presented to the main hospital at a major academic center complaining of an injury sustained performing CrossFit between June 2010 and June 2016 were identified. Injuries were classified by anatomical location (eg, knee, spine). For patients with spinal injuries, data were collected including age, sex, body mass index (BMI), CrossFit experience level, symptom duration, type of symptoms, type of clinic presentation, cause of injury, objective neurological examination findings, imaging type, number of clinic visits, and treatments prescribed. Results: Four hundred ninety-eight patients with 523 CrossFit-related injuries were identified. Spine injuries were the most common injuries identified, accounting for 20.9%. Among spine injuries, the most common location of injury was the lumbar spine (83.1%). Average symptom duration was 6.4 months ± 15.1, and radicular complaints were the most common symptom (53%). A total of 30 (32%) patients had positive findings on neurologic examination. Six patients (6.7%) required surgical intervention for treatment after failing an average of 9.66 months of conservative treatment. There was no difference in age, sex, BMI, or duration of symptoms of patients requiring surgery with those who did not. Conclusions: CrossFit is a popular, high-intensity style workout with the potential to injure its participants. Spine injuries were the most common type of injury observed and frequently required surgical intervention.

Exploring Gaps in Concussion Knowledge and Knowledge Translation Among Coaches of Youth Female Hockey Objective: To better understand the level of concussion knowledge of youth female hockey coaches and to identify preferred methods of knowledge translation for this population. Design: Cross-sectional survey. Setting: Participants independently completed written surveys before in-person concussion information sessions or online surveys through link provided in emails. Participants: Convenience sampling yielded 130 coaches of youth female hockey from Canada. Main Outcome Measures: Knowledge level on concussion, resources from which coaches obtained information on concussion, opinions on the current level of concussion knowledge, and knowledge translation. Results: Coaches demonstrated adequate knowledge on concussion, achieving 84% correct on true–false questions and 92% correct on symptom identification accuracy. However, coaches showed limited awareness of concussion specific to mechanisms for injury (identification) and postconcussion symptoms. Internet resources were rated as the most used resources for concussion yet were not rated very helpful. Nonetheless, coaches indicated online courses and web sites as the most preferred method for concussion knowledge translation. Conclusions: Youth female hockey coaches have overall adequate knowledge of concussion; however, gaps in knowledge do exist. Future efforts to raise the concussion knowledge among coaches of female youth hockey should include information specific to the mechanism of injury, along with sign and symptom identification, with particular attention paid to emotional symptoms. Given the reported preferences and the widespread availability of the Internet, further exploration and research validation of online courses and web sites tailored to the youth female hockey community is encouraged.

Self-Reported Mild Traumatic Brain Injuries in Relation to Rumination and Depressive Symptoms: Moderating Role of Sex Differences and a Brain-Derived Neurotrophic Factor Gene Polymorphism Objective: Mild traumatic brain injuries (mTBIs) have frequently been associated with the emergence and persistence of depressive symptoms. However, the factors which contribute to the increased risk for depression after these head injuries remain unclear. Accordingly, we examined the relationship between frequency of self-reported mTBIs and current symptoms of depression and the mediating role of rumination and cognitive flexibility. We also examined whether these relations were moderated by sex differences and the presence of the Val66Met polymorphism in a gene coding for brain-derived neurotrophic factor (BDNF). Design: Retrospective, cross-sectional. Setting: Carleton University. Participants: Two hundred nineteen Carleton University undergraduate students. Main Outcome Measures: Cognitive flexibility as assessed by the Wisconsin Card Sorting Task (WCST); subtypes of rumination (Ruminative Response Scale; Treynor, Gonzalez, and Nolen-Hoeksema, 2003); depressive symptoms (Beck Depression Inventory; Beck, Ward, and Mendelson, 1961). Results: Greater frequency of self-reported mTBIs was associated with more frequent depressive rumination among women, but not men, which was accompanied by elevated current depressive symptoms. In addition, among Met allele carriers of the BDNF polymorphism, but not those who were Val homozygotes, greater frequency of mTBIs was related to higher levels of brooding, which was accompanied by heightened depressive symptoms. Brain-derived neurotrophic factor genotype also moderated the relationship between self-reported mTBIs and cognitive flexibility in that more frequent mTBIs were associated with more perseverative errors on the WCST among Met carriers, but not Val homozygotes. Conclusions: The present findings raise the possibility that the evolution of depression after mTBIs may be dependant on a BDNF polymorphism and sex differences.