Sports Medicine Research: In the Lab & In the Field (Sports Med Res)
Friday, August 29, 2014

Helmet to Helmet II: Full Data Set Show Helmet Type Does Not Reduce Risk of Concussion in High School Football

Protective Equipment and Player Characteristics Associated With the Incidence of Sport-Related Concussion in High School Football Players: A Multifactorial Prospective Study
McGuine A., Hetzel T., McCrea M., Brooks, M. Am J Sports Med. 2014; ahead of print.

Take Home Message: No particular brand of helmet reduces the risk of sustaining a sports-related concussion among high school football athletes. Athletes who wore custom fitted mouth guards and had a history of concussions had a higher rate of concussion.

In September of 2013, preliminary findings from a concussion surveillance program found that contrary to recent equipment manufacturers' claims there were no associations with a specific helmet brand and a reduction in the risk and severity of sports-related concussions (SRC) during a single football season. These finding were noteworthy because they were some of the first to comment on the risk of SRC in high school athletes who may be using newer helmet technology. In the current study, the same research group expands upon their data set by pooling data from the 2012 and 2013 football seasons.
Wednesday, August 27, 2014

If You Don't Let Your Head Heal Your Knee May be Next

Sports-related concussion increases the risk of subsequent injury by about 50% in elite male football players

Nordström A, Nordström P and Ekstran J. Br J Sports Med. 2013 [Epub Ahead of Print].

Take Home Message: After a concussion, elite level European football players have an elevated risk of injury for at least 1 year following a concussion.

Some athletes have mild cognitive impairments after they return to play following a concussion. Whether or not these impairments place an athlete at an increased risk of a subsequent injury is not understood. Therefore, Nordström and colleagues completed a prospective cohort study to “examine the risk of subsequent injury after return to play in football [soccer] players who had sustained concussions.”
Monday, August 18, 2014

Are Your Genes Acting Together Against Your ACL?

Interactions between collagen gene variants and risk of anterior cruciate ligament rupture

O’Connell K., Knight H., Ficek K., Leonska-Duniec A., Maciejewska-Karlowska A., Sawczuk M., Stepien-Slodkowska M., O’Cuinneagain D., van der Merwe W., Posthumus M., Ciezczyk P., Collins M. Eurpoean Journal of Sport Science.

Take Home Message: An individual with a specific genetic variation related to collagen type III may be more likely to have an ACL injury. Additionally a gene-gene interaction may exist between two genetic variants related to collagen that increase the risk of ACL injury in females.

Various types of collagen (for example, types III, V, VI, XII) are present in the anterior cruciate ligament (ACL). We’ve previously seen evidence that genetic variations among genes that produce components of the ACL may increase the risk of ACL tears but very few investigators have looked at the risk of an ACL injury when someone has multiple genetic variations. Four genes of interest may be those that produce types III, V, VI, and XII collagen. Therefore, the authors investigated whether individual gene variants within COL3A1, COL6A1, COL5A1, and COL12A1, as well as the combination of these variants increased the risk of ACL rupture. The authors explored these genetic variants in 2 different populations. The first population consisted of 477 Caucasian South African of which 242 (177 male, 65 female) were surgically diagnosed with an ACL rupture and 235 (145 male, 90 females) self-reported no history of an ACL injury. The second group consisted of 234 Polish participants, where 91 participants (71 male, 20 female) were surgically diagnosed with an ACL rupture and 143 (99 male, 44 female) self-reported no previous ACL injury. The authors matched the injured and uninjured participants in each cohort for weight and height. Additionally, the Polish group was matched for sex. To determine gene-gene interaction researchers used previous genes that were individually associated with ACL injury risk (COL5A1 and COL12A1) and separately analyzed male and female subgroups. The researchers demonstrated an association within the Polish cohort between a COL3A1 variant and ACL rupture, where those carrying that variation were almost 4 times more at risk for an ACL rupture compared with controls. No genetic associations to ACL ruptures were found within the South African cohort. Finally, there was a gene-gene interaction among females in both cohorts. Females carrying a COL5A1 variation and the COL12A1 variation were more likely to have an ACL injury compared with females not carrying these variations. There were no gene-gene interactions within the male sub-group.

This was a novel study that found that there may be a gene-gene interaction that increases a female’s risk to ACL rupture. The interaction is important because if we only looked at one genetic variation it may mask the risk because the true risk required a second variation to be present. This highlights the complexity of using genetic risk factors. If we want to use genetic testing to identify a patient at high risk we may need to look at the whole genetic picture, or as much as possible. Owing to the fact that an ACL injury has many intrinsic and extrinsic factors contributing to the risk, future research should consider further gene-gene interactions as well as the role of an interaction between environment and genetics. Clinically, these findings may help explain why females may be at a greater risk of ACL injury, and medical personnel should be educating females on these risks as well as preventative measures.

Questions for Discussion: Does knowing genetic risk change how you educate athletes on risks and prevention for ACL injuries? Do you think genetic screening could lead to better preventative measures?

Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban

Related Posts:

O'Connell K, Knight H, Ficek K, Leonska-Duniec A, Maciejewska-Karlowska A, Sawczuk M, Stepien-Slodkowska M, O'Cuinneagain D, van der Merwe W, Posthumus M, Cieszczyk P, & Collins M (2014). Interactions between collagen gene variants and risk of anterior cruciate ligament rupture. European Journal of Sport Science, 1-10 PMID: 25073002
Wednesday, August 13, 2014

Make Sure You Charge That Phone Before Measuring Anterior Tibial Translation

Smartphone versus knee ligament arthrometer when size does not matter

Ferretti A, Valeo L, Mazza D, Muliere L, Iorio P, Giovannetti G, Conteduca F, Iorio R. Int Orthop. 2014. [Epub Ahead of Print].

Take Home Message: A mobile phone arthrometer application may be a reliable alternative to the KT-1000 when measuring anterior tibial translation following an anterior cruciate ligament injury.

Clinicians may use a direct measurement of anterior tibial translation (ATT) to assess joint laxity in a knee after an anterior cruciate ligament (ACL) injury or reconstruction. The most common instrument to measure ATT is the KT-1000; however, access to this tool is limited due its size and cost. Clinicians would benefit from a reliable, cost effective method of measuring ATT. Therefore, Andrea and colleagues designed and evaluated a Smartphone application which assesses ATT.
Monday, August 11, 2014

Emergency Room Visits for Sports Injuries

Epidemiology of Hospital-Based Emergency Department Visits Due to Sports Injuries

Nalliah RP, Anderson IM, Lee MK, Rampa S, Allareddy V, & Allareddy V. Pediatric Emergency Care.  2014 30(8):511 - 515.

Take Home Message:  Sports-related injuries among teenagers accounts for over 430,000 emergency room visits in the United States in 2008 and represent a significant financial burden to the healthcare system.     

Sports-related injuries in teenagers result in a significant number of emergency room visits, which can result in relatively large direct costs.  However, little is known about national estimates of how many emergency room visits actually occur as well as the direct costs affiliated with this.  The authors of this retrospective research study analyzed the 2008 Nationwide Emergency Department Sample data set for patient variables (e.g., age, sex, type of injury) among patients aged 13 to 19 years who visited an emergency room for a sports-related injury.
Wednesday, August 6, 2014

Female Athletic Trainers Balancing Life and Motherhood

Motherhood and Work-Life Balance in the National Collegiate Athletic Association Division I setting: Mentors and the Female Athletic Trainer

Eason CM, Mazerolle SM, & Goodman A. J Athl Train.  2014 (3):000-000. doi: 10.4085/1062-6050-49.3.03

Take Home Message:  Female mentors/role models who are successfully maintaining work-life balance are critical to the success and retention of quality female athletic trainers at the NCAA Division I level. 

Work-life balance (WLB) is a difficult thing to accomplish for clinicians in sports medicine, especially at the NCAA Division I level and for female athletic trainers (ATs) who may want to become mothers.  Young female AT students and professionals may benefit from having positive role models who exhibit appropriate strategies to achieve WLB.  This study aimed to see how role models and mentors within athletic training influence female ATs in the NCAA Division I setting.
Monday, August 4, 2014

Concussion Indicators of a Phenomenon Yet to be Defined

Concussion Guidelines Step 1: Systematic Review of Prevalent Indicators

Carney N., Ghajar J., Jagoda A., Bedrick S., Davis-O’Reilly, C., Coudray Hd., Hack D., Helfand N., Huddleston A., Nettleton T., Riggio S. Neurology.2014;7(3):S3-S15.

Take Home Message: Prevalent and consistent indicators of a concussion include observing disorientation or confusion immediately after the injury, and slower reaction time, poor balance, and impaired verbal learning and memory within 2 days after the injury.

We lack a widely accepted definition for a concussion. An evidence-based development of a standardized concussion definition would enable medical personnel to determine a concussion injury using specific diagnostic criteria as well as prognostic indicators such as signs and symptoms. Therefore, the purpose of the current systematic review is to provide evidence-based data on indicators of a concussion injury.