Michael C. Meyers

Incidence, Causes, and Severity of High School Football Injuries on FieldTurf versus Natural Grass: A 5-Year Prospective Study

Background Numerous injuries have been attributed to playing on artificial turf. Recently, FieldTurf was developed to duplicate the playing characteristics of natural grass. No long-term study has been conducted comparing game-related, high school football injuries between the 2 playing surfaces. Hypothesis High school athletes would not experience any difference in the incidence, causes, and severity of game-related injuries between FieldTurf and natural grass. Study Design Prospective cohort study. Methods A total of 8 high schools were evaluated over 5 competitive seasons for injury incidence, injury category, time of injury, injury time loss, player position, injury mechanism, primary type of injury, grade and anatomical location of injury, type of tissue injured, head and knee trauma, and environmental factors. Results Findings per 10 team games indicated total injury incidence rates of 15.2 (95% confidence interval, 13.7-16.4) versus 13.9 (95% confidence interval, 11.9-15.6). Minor injury incidence rates of 12.1 (95% confidence interval, 10.5-13.6) versus 10.7 (95% confidence interval, 8.7-12.7), substantial injury incidence rates of 1.9 (95% confidence interval, 1.4-2.6) versus 1.3 (95% confidence interval, 0.8-2.1), and severe injury incidence rates of 1.1 (95% confidence interval, 0.7-1.7) versus 1.9 (95% confidence interval 1.2-2.8) were documented on FieldTurf versus natural grass, respectively. Multivariate analyses indicated significant playing surface effects by injury time loss, injury mechanism, anatomical location of injury, and type of tissue injured. Higher incidences of 0-day time loss injuries, noncontact injuries, surface/epidermal injuries, muscle-related trauma, and injuries during higher temperatures were reported on FieldTurf. Higher incidences of 1- to 2-day time loss injuries, 22+ days time loss injuries, head and neural trauma, and ligament injuries were reported on natural grass. Conclusions Although similarities existed between FieldTurf and natural grass over a 5-year period of competitive play, both surfaces also exhibited unique injury patterns that warrant further investigation.

Downhill ski injuries in children and adolescents.

Downhill skiing is considered to be an enjoyable activity for children and adolescents, but it is not without its risks and injuries. Injury rates now range between 3.9 and 9.1 injuries per 1000 skier days, and there has been a well documented increase in the number of trauma cases and fatalities associated with this sport. Head and neck injuries are considered the primary cause of fatal injuries and constitute 11–20% of total injuries among children and adolescents. Cranial trauma is responsible for up to 54% of total hospital injuries and 67% of all fatalities, whereas thoracoabdominal and spine injuries comprise 4–10% of fatalities. Furthermore, there has been an increase in the proportion of upper extremity trauma with acromioclavicular dislocations, and clavicle and humeral fractures accounting for the majority (22–79%) of the injuries. However, the most common and potentially serious injuries in children and adolescents are those to the lower extremity, with knee sprains and anterior cruciate ligament tears accounting for up to 47.7% of total injuries. Knee sprains and grade III ligament trauma associated with lower leg fractures account for 39–77% of ski injuries in this young population.Approximately 15% of downhill skiing injuries among children and adolescents are caused by musculoskeletal immaturity. Other factors include excessive fatigue, age, level of experience, and inappropriate or improperly adjusted equipment. Collisions and falls constitute a significant portion (up to 76%) of trauma, and are commonly associated with excessive speed, adverse slope conditions, overconfidence leading to carelessness, and behavioural patterns within and among gender. The type and severity of injuries are typically functions of biomechanical efficiency, skiing velocity or slope conditions; however, a multiplicative array of intrinsic and extrinsic factors may simultaneously be involved. Despite extensive efforts to provide a comprehensive picture of the aetiology of injury, limitations have hampered reporting. These limitations include age and injury awareness, data collection challenges, lack of uniformity in the definition or delineation of age classification and lack of knowledge of predisposing factors prior to injury.Since skill level is the primary impetus in minimising ski injuries, formal instruction focusing on strategies such as collision avoidance and helmet use, fall training minimising lower extremity trauma, altering ski technique and avoiding behaviours that lead to excessive risk are, therefore, highly recommended. Skiing equipment should be outfitted to match the young skier’s height, weight, level of experience, boot size and slope conditions. Additionally, particular attention should be paid to slope management (i.e. overcrowding, trail and obstacle marker upkeep) and minimising any opportunity for excessive speed where children are present. Whether increases in knowledge, education and technology will reduce predisposition to injury among this population remains to be seen. As with all high-risk sports, the answer may lie in increased wisdom and responsibility of both the skier and the parent to ensure an adequate level of ability, self-control and simply common sense as they venture out on the slopes.

Incidence, Mechanisms, and Severity of Game-Related College Football Injuries on FieldTurf Versus Natural Grass: A 3-Year Prospective Study

Background Numerous injuries have been attributed to playing on artificial turf. More recently, FieldTurf was developed to duplicate the playing characteristics of natural grass. No long-term studies have been conducted comparing game-related collegiate football injuries between the 2 playing surfaces. Hypothesis Collegiate athletes do not experience any difference in the incidence, mechanisms, and severity of game-related injuries between FieldTurf and natural grass. Study Design Cohort study; Level of evidence, 2. Methods Twenty-four universities were evaluated over 3 competitive seasons for injury incidence, injury category, time of injury, injury time loss, player position, injury mechanism, primary type of injury, grade and anatomical location of injury, type of tissue injured, trauma (head, knee, and shoulder), and environmental factors. Results In sum, 465 collegiate games were evaluated for game-related football injuries sustained on FieldTurf or natural grass during 3 seasons. Overall, 230 team games (49.5%) were played on FieldTurf versus 235 team games (50.5%) played on natural grass. A total of 2253 injuries were documented, with 1050 (46.6%) occurring during play on FieldTurf, and 1203 (53.4%) on natural grass. Multivariate analysis per 10 team games indicated significantly lower total injury incidence rates, F(3, 2249) = 3.468, P = .016, n — β =0.778, on FieldTurf, 45.7 (95% confidence interval [CI], 44.2-46.3), versus natural grass, 51.2 (95% CI, 49.8-51.7). Significantly lower minor injury incidence rates, 38.0 (95% CI, 36.9-38.5) versus 39.9 (95% CI, 39.1-40.0, P = .001), substantial injury incidence rates, 5.0 (95% CI, 4.3-5.6) versus 7.2 (95% CI, 6.6-7.7, P = .020), and severe injury incidence rates, 2.7 (95% CI, 2.1-3.3) versus 4.1 (95% CI, 3.5-4.1; P = .049), were documented on FieldTurf versus natural grass, respectively. Multivariate analyses also indicated significantly less trauma on FieldTurf when comparing injury time loss, injury situation, grade of injury, injuries under various field conditions, and temperature. No significant differences in head, knee, or shoulder trauma were observed between playing surfaces. Conclusion FieldTurf is in many cases safer than natural grass. It must be reiterated, however, that the findings of this study may be generalizable to only this level of competition. Because this study is still in the early stages, investigation is ongoing.

Rock Climbing Injuries

SummaryRock climbing has become increasingly popular in the past decade. However, the increased participation exposes a greater number of climbers to potential injury. The risks involved with climbing increase in proportion to the skill-level of the climber: the higher the skill-level, the more hours are required for training and on more difficult routes.The hands are used as tools for the ascent, with much of the climber’s weight placed upon the fingers and also distributed through the wrist, elbow and shoulders. The combination of repetitive climbing and the excessive weight-bearing demands of the sport result in cumulative trauma to the upper limbs.Prevention should begin with educating climbers on the potential risk for injury. Although adequate rest between climbs and decreased training when pain is first encountered would aid in alleviating numerous problems, additional research directed towards improving training, treatment and rehabilitation programmes is warranted.

Physiological and sport-specific skill response of olympic youth soccer athletes.

Although many studies have been focused on soccer athletes, no comprehensive studies have been conducted on adolescent soccer athletes in the United States. Therefore, the purpose of this study was to quantify the physiological and sport-specific skill characteristics of Olympic Developmental Program (ODP) soccer athletes by age group and game experience. Following written, informed consent, 59 male athletes (age = 14.6 ± 2.0 years; wt = 60.5 ± 1.4 kg; ht = 172.4 ± 1.2 cm) completed a battery of tests to determine aerobic power (Vo2max), heart rate (HRmax), ventilation (VEmax), respiratory exchange ratio (RER), anaerobic threshold (AT), blood pressure (BPrest/max), anaerobic power/capacity [peak power (PP), mean power (MP), total work output (TWO), fatigue index (FI)], leg power [vertical squat jump (VJS), countermovement jump (VJC)], body composition [percent body fat (%BF), lean body mass (LBM)], joint range of motion (trunk, back, hip, knee, and ankle), and agility/sport-specific skills (T-test, line drill test, juggling test, Johnson wall volley, and modified-Zelenka circuit). Factor analyses with subsequent multivariate analyses of variance (MANOVAs) indicated significant main effects across age (p = 0.0001) but not by game experience (p = 0.82). Older athletes exhibited greater height, weight, LBM, VEmax, Timemax, PP, TWO, and VSJ values than younger athletes. Although not significant, there were differences with increasing age in the agility tests (T-test, wall volley, and juggling test). In conclusion, improvements in anaerobic power, agility, and sport-specific skill should be addressed at this developmental level of competition.

Allograft Failure in Cruciate Ligament Reconstruction Follow-up Evaluation of Eighteen Patients

Previous authors have reported the efficacy of cruciate ligament allograft reconstruction of the knee suggesting that allograft strength is not significantly different than that of autografts. The purpose of this study was to elicit the cause of a higher-than-expected failure rate in cru ciate ligament allograft reconstructions. After clinical di agnoses, 12 male and 6 female patients with cruciate ligament instability underwent intraarticular allograft re construction followed by an aggressive rehabilitation program. Deep-frozen, freeze-dried, ethylene oxide- sterilized, bone-patellar tendon-bone allografts were re hydrated, prestressed, and implanted by an open or ar throscopically assisted technique. Results revealed 6 of 18 failures. Knee instability, postoperative complica tions, and roentgenographic changes were evident. Evaluation of procurement technique showed that graft failure was significantly correlated with time to implan tation. A significant difference in mean time from pro curement and deep freezing to freeze-drying and ster ilization between failed-versus-successful grafts was 265.5 ± 61.9 versus 66.8 ± 43.8 days, respectively. Total mean time of failed grafts from procurement to implantation was significantly greater (528.3 ± 75.1 ver sus 207.3 ± 53.1 days) than for successful grafts. All graft failures came from the same batch number. These findings indicate that cruciate ligament allograft recon struction can be successful; however, longer shelf life negatively affects graft integrity.

Exercise Performance of Lower-Extremity Amputees

SummaryA comparison of the literature quantifying the energy expended during ambulation of healthy individuals and those with amputation of the lower extremity is difficult as study parameters and methods are inconsistent. However, the energy cost of ambulation is greater for amputees than for nonamputees. Ascending level of amputation appears to be associated with increasing metabolic demand. There appears to be a difference in energy cost of ambulation following different surgical procedures. The literature regarding energy cost of ambulating with different lower-extremity prostheses is equivocal, with the exception of the contoured adducted trochanteric-controlled alignment method (CAT-CAM) socket for above-knee amputees and the new energy-storing (Proteor™) foot for traumatic below-knee amputees, which may decrease energy expenditure during ambulation. Therefore, it is reasonable to recommend that energy cost of ambulation be considered when deciding on the most efficacious surgical procedure, and metabolic efficiency of gait be considered when selecting prostheses most suitable for lower-extremity amputees.Though limited research is currently available, it appears that training or physical conditioning for the lower-extremity amputee, particularly with cardiopulmonary or vascular insufficiency, may decrease the metabolic cost of ambulation. More research is needed regarding the benefits of aerobic exercise and the safest, most effective exercise regimens for reducing metabolic costs of ambulation in lower-extremity amputees.

Injuries in intercollegiate rodeo athletes

Collegiate rodeo athletes (N = 156) in the National Intercollegiate Rodeo Association (NIRA) Southern Re gion, were examined for injuries during a 7 month (10 rodeo) season from 1987 to 1988. Sixty-two athletes sustained a total of 138 acute injuries resulting from 3292 exposures. One hundred twenty-seven injuries (92% of total injuries) occurred in the roughstock and steer wrestling events, and 11 injuries (8%) occurred in the roping and female events. When calculating oppor tunity for injury, rodeo athletes face an 89% potential for injury per season. Ninety-one of the injuries incurred were upper body injuries; 47 were lower body injuries. A 6:1 exposure to injury ratio among roughstock events exemplifies the magnitude of injury potential in this sport, affecting 25% of roughstock competitors. Con tusions, strains, and concussions comprised 42%, 16%, and 11 % of the total injuries, respectively, whereas fractures and dislocations comprised only 5% of the total. Twenty-three percent of the injuries oc curred during the completion of an athletes ride, with 21 % of injuries attributed to equipment mishaps. Fre quency of injury by performance, relation of seasonal participation and exposure to injury, orthotic care, use of conditioning programs, medication history, and need for enhanced sports medicine education in this sport are discussed.

Ulnar Neuropathy of the Elbow

SummaryUlnar nerve entrapment is the second most common compressive neuropathy in the upper extremity because of its anatomy and superficial location. Major aetiological factors in the development of ulnar neuropathy of the elbow are compression, inherent anatomical structures, or lesions within the cubital tunnel. Extrinsic nerve compression may be elicited by acute or recurrent trauma. Nerve mobility may be impeded by congenital deformities. Ulnar nerve dysfunction has been associated with metabolic conditions, certain occupations and athletes involved in repetitive overhead activities. Ulnar nerve injuries may result in both motor and sensory abnormalities.Common symptoms include point tenderness, digital numbness and hand weakness. Evaluation of suspected neuropathy includes physical inspection for muscle atrophy, bony or muscle hypertrophy, deformities, digital clawing and a radiographic examination. Clinical techniques include the elbow flexion test, strength testing of hand intrinsics, flexor carpi ulnaris and digitorum profundus, and Tinel’s sign. Sensory testing and McGowan’s grading system may confirm the diagnosis and prognosis. Treatment options range from conservative (i.e. rest, splinting, non-steriodal anti-inflammatory drugs, ice and abstinence) to radical surgical intervention (i.e. decompression, medial epicondylectomy and anterior transposition). In the throwing sport athlete, nerve involvement typically occurs along with other medial elbow problems.

False negative bone scan in a female runner

Stress fractures are more prevalent in todays fitness cognizant society. Stress fractures of the femoral neck are common and present with specific symptoms and findings. The diagnosis is based on clinical history, physical exam, radiography, bone scintigraphy, and computed tomography (C.T.) scans. The triple-phase bone scan is the most sensitive test for the diagnosis of stress fractures and is considered the gold standard for the diagnosis of the occult stress fracture. This case presents a 42-yr-old female marathon runner who presented with hip pain and clinical symptoms indicating a stress fracture of the femoral neck. Initial radiographs and a triple-phase bone scan were negative. When symptoms persisted, a repeat x-ray revealed a femoral neck fracture of the superior surface. In spite of a false negative bone scan, clinical suspicion allowed appropriate treatment of this femoral neck stress fracture. Nondiagnosed stress fractures of the femoral neck may lead to severe disability, including avascular necrosis of the femoral head. Therefore, clinical index of suspicion is very important even if ancillary tests are nondiagnostic.