Sports Medicine Research: In the Lab & In the Field: Knee Injuries Sustained Prior to Collegiate Athletics may be a Factor in Identifying Athletes at Risk for Reinjury (Sports Med Res)
Wednesday, March 12, 2014

Knee Injuries Sustained Prior to Collegiate Athletics may be a Factor in Identifying Athletes at Risk for Reinjury

Effects of Prior Knee Surgery on Subsequent Injury, Imaging, and Surgery in NCAA Collegiate Athletes.

Rugg CM, Wang D, Sulzicki P, and Hame SL. Am J Sports Med. 2014. [Epub Ahead of Print]
http://ajs.sagepub.com/content/early/2014/02/11/0363546513519951.short

Take Home Message: College athletes who had orthopaedic surgery in high school miss more days of collegiate competition than athletes without a history of orthopaedic surgery. More specifically, athletes with a history of knee surgery were more likely to sustain another knee injury or require surgery while in college.

Injuries are increasingly common in high school athletics. Athletes with a history of injury may be at greater risk for reinjury or a contralateral injury but it remains unclear if an injury in high school may influence an athlete’s competitive career in college. If we understand the health outcomes after serious injuries that require surgery in high school then we could identify incoming athletes who may be at a higher risk of reinjury and focus treatment and/or conditioning on correcting any functional deficits. Therefore, Rugg and colleagues completed a cohort study to determine the athletic and medical outcomes among National Collegiate Athletic Association Division I athletes with and without a history of surgery prior to college competition. The authors included athletes who had an initial preparticipation evaluation at one university between fall 2003 and spring 2008. All data were collected via athletic training room records and institutional archives. The authors assessed sport played, seasons played, games played, injury type, and days missed due to injury. All eligible medical records were classified into either an orthopedic surgery cohort (ortho) or a control (no history of orthopedic surgery) group. The ortho cohort included athletes who had surgery before their first collegiate preparticipation evaluation. The authors included 456 athletes (104 ortho, 352 control) from 10 sports: football, baseball, men’s and women’s volleyball, men’s and women’s basketball, gymnastics, softball, and men’s and women’s soccer. Of the 104 athletes classified into the ortho group, 48 had knee surgery. No difference was found between those with and without a history of orthopaedic surgery with respect to seasons played and games played. Overall, athletes who sustained an injury, which required surgery, prior to participation in college athletics missed more days due to injury than athletes without a history of surgery (34 days missed/season). This was also true for the subset of athletes who had a history of knee surgery (99 days missed/season). In fact, athletes with a history of knee surgery also had an increased risk of knee reinjury and knee surgery.

This study is very helpful for clinicians who treat incoming collegiate-level athletes. Clinicians in these settings should be diligent in screening incoming athletes who have a history surgery for functional deficits. If these deficits can be identified, clinicians can then implement a therapeutic regiment to correct them, in turn decreasing the chance of injuries. While these results appear helpful, clinicians should also understand the limitations surrounding the current study. Firstly, the current study was conducted at a single institution, which limits the generalizability of the results. Furthermore, incoming athletes who redshirted were included in this study. These athletes did not compete in as many games overall and therefore are not an ideal comparison to other athletes who competed for a full season. While future research should look to expand the current study to more institutions in different geographical areas, as well as more closely control the comparability of the included athletes, clinicians should be meticulous in screening all incoming athletes for previous injuries, especially knee injuries. Clinicians may also consider screening those athletes with previous injuries for any specific functional deficits that may place that athlete at a greater risk of injury in the future, then seek to address those deficits.

Questions for Discussion: Does your current preparticipation examination include screening for previous injuries and/or functional deficits stemming from those injuries? If so, what proactive steps do you take to address the deficits caused by the previous injuries?

Written by: Kyle Harris
Reviewed by: Jeffrey Driban

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Rugg, C., Wang, D., Sulzicki, P., & Hame, S. (2014). Effects of Prior Knee Surgery on Subsequent Injury, Imaging, and Surgery in NCAA Collegiate Athletes The American Journal of Sports Medicine DOI: 10.1177/0363546513519951

3 comments:

Gabe Fife said...

one of the issues of studies claiming to report epidemilogical data is not adhering to accepted definitions of injury incidence in respect to exposure. this study reports some form of exposure by the career length and percentage of games played between groups. i'd say the most common accepted form of exposure is that of "athlete exposures" or minutes of exposure (which is typically thought of as most accurate). because we do not know the true exposure to injury for each individual athlete, determining true risk, relative to that of a control group (usually reported/calculated as relative risk) is not really possible.

actually had an email exchange about some of these topics today, specifically reporting injuries by a group, rather than per individual's exposure. while looking into this i came across Willem Meeuwisse's dissertation which is quite all inclusive. He comes of up with the following:

He states in reference to the NCAA-ISS and SIMS:

"However, a principle weakness with these two systems is that the exposure information is calculated as a group index. The number of players is multiplied by the number of sessions to obtain a weekly exposure measure. When these data are compared to individual injury data, a disparity is created between the unit of observation for exposure (the team), and that for the recording of injury (the individual). Babbie outlined the concept of ecologic fallacy whereby erroneous conclusions are drawn on individuals based upon the observation of groups. Moreover, the participation of an individual can not be followed over time to assess the level of play prior to injury, or potential time loss after injury. This significantly weakens the ability to provide evidence of causal association between a potential risk factor and subsequent injury. A more appropriate approach, if exposure is needed for analysis, is to document individual exposure."

The reference for Babbie:

Babbie E. The Practice of Social Research. Belmont, California: Wadsworth Publishing Company, 1989.

Jeffrey Driban said...

Gabe, great point.While this definitely would influence the estimates for new injuries do you think this compromises the validity of the overall findings?

Gabe Fife said...

i'd say yes...its a bit like if someone were to say that there was a significant difference (using a p value), however clinically when effect sizes were taken into account, there were no clinically meaningful differences. conclusions could be different. but i'd also say that it doesnt mean they aren't on to something...best to do what science does best..do the study similar in some way along with accepted epidemiological standards....this is quite common to see in most "injury epidemiology" studies...even the IOC doesn't report in standard measures all the time...they're all over the board..

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