Epidemiology of Hamstring Tears in National Collegiate Athletic Association Athletes: Findings From the National Collegiate Athletic Association Injury Surveillance Program Between 2014/2015 and 2018/2019.

OBJECTIVE: To describe the epidemiology of hamstring tears in National Collegiate Athletic Association (NCAA) sports. DESIGN: Descriptive epidemiology study. Athletic trainers from NCAA schools reported injuries to the NCAA Injury Surveillance Program. SETTING: A convenience sample of NCAA hamstring tear injuries during the 2014/2015 through 2018/2019 academic years. PATIENTS OR PARTICIPANTS: NCAA student-athletes. INDEPENDENT VARIABLES: Sport, sex, event type, season segment, injury history, and activity at the time of injury. MAIN OUTCOME MEASURES: Injury counts, rates, and proportions were used. RESULTS: Two thousand ninety-six hamstring tears from 8 474 400 athlete-exposures (AEs) were reported (2.47 per 10 000 AEs). Rates were highest in Men's Soccer (5.97 per 10 000 AEs) and Women's Soccer (3.13 per 10 000 AEs), among all Men's and Women's sports, respectively. Competition-related rates in Men's and Women's sports were highest in 2015 to 2016 then followed a decreasing pattern across the remainder of the study period. Among sex-comparable sports, rates were higher in men's (compared with women's) Baseball/Softball, Soccer, and Track and Field. The prevalence of recurrent injuries was comparable among men's (14.8%) and women's (11.5%) sports. Time loss hamstring tears were more prevalent in Men's sports than Women's sports [injury proportion ratio = 1.33; 95% confidence interval, (1.21, 1.47)]. CONCLUSIONS: Overall, hamstring tear rates were higher across all Men's sports compared with Women's sports. Rates across event type were comparable in several sports; and so, adjustments to practice are needed considering that practice environments are more modifiable than competitions. Indeed, improving hamstring tear prevention programs to reduce the burden of this injury in NCAA athletes remains critical.

The Role of Level of Play in Concussions in High School Athletes.

OBJECTIVES: To examine level of play (LOP) as a risk factor for concussion severity and recovery-related outcomes among high school athletes, stratified by sex, and among boys, by sport (football, non-football male sports). DESIGN/SETTING: Secondary analysis of data collected through the High School Reporting Information Online surveillance system for academic years 2007-2008 through 2018-2019. PARTICIPANTS: A total of 9916 concussions were reported between the academic years 2007-2008 and 2018-2019 from 9 sports (5189 from football; 2096 from non-football male sports; 2631 from female sports). MAIN OUTCOME MEASURE: Examined the association between LOP (Freshman, Junior Varsity [JV], and Varsity teams) and concussion outcomes (number of concussion symptoms, symptom resolution time [SRT], and time to return to play [RTP]). RESULTS: Compared with Varsity football athletes, concussed JV football athletes had on average 0.19 fewer concussion symptoms, longer SRT (>1 week vs <1 week: odds ratio [OR] = 1.3; 95% confidence interval [CI], 1.1-1.5), and longer RTP (1-3 weeks vs <1 week: OR = 1.5; 95% CI, 1.2-1.9; >3 weeks vs <1 week: OR = 1.6; 95% CI, 1.1-2.3). Compared with Varsity football athletes, Freshman football athletes had on average 0.48 fewer concussion symptoms, longer SRT (OR = 1.3; 95% CI, 1.1-1.5), and longer RTP (1-3 weeks vs <1 week: OR = 1.5; 95% CI, 1.1-2.0; >3 weeks vs <1 week: OR = 2.0; 95% CI, 1.3-3.0). Similarly, compared with female athletes on Varsity teams, concussed JV female athletes had longer RTP (1-3 weeks vs <1 week: OR = 1.8; 95% CI, 1.2-2.7). Trend analyses revealed an increase in the number of concussion symptoms between 2015-2016 and 2018-2019, a decrease between 2009-2010 and 2018-2019 for SRT of less than 1 week, and an increase between 2014-2015 and 2018-2019 for RTP of less than 1 week among Varsity football athletes. Among Varsity female athletes, there was a linear decrease during the study period for RTP of less than 1 week. CONCLUSIONS: Despite a higher number of symptoms overall and in recent years, Varsity football players had shorter RTP than Freshman and JV athletes.

Traumatic dental injuries in high school athletes in the United States of America from 2005 to 2020.

BACKGROUND/AIM: Participation in sports activities is a source of dental injury. Despite recommendations for the use of mouthguards, athletes underutilize them. The aim of this study was to provide estimates of dental injuries, the mechanism of injuries and the utilization of mouthguards in high school sports. MATERIALS AND METHODS: This study was a secondary analysis of an existing dataset of a convenience sample of the National High School Sports-Related Injury Surveillance Study. Data of athletic exposures, dental injuries, mouthguard usage, and mechanism of injury from the 2005/2006 to the 2019/2020 academic years were analyzed. RESULTS: During the study period, there were 459 dental injuries in 49,987,927 athletic exposures resulting in a dental injury rate of 0.9 per 100,000 athletic exposures (AE). Slightly more than half of the traumatic dental injuries were sustained during competition (n = 256; 55.8%) and the rest (n = 200; 43.6%) were sustained during practice. The rate of dental injury in competition was 3.6 times higher than the rate in practice (RR: 3.6, 95% CI: 3.0-4.4). Dental injuries comprised 0.4% of the total 108,574 injuries sustained by athletes. Among girls' sports, field hockey had the highest rate (3.5 per 100,000 AE) and among boys' sports, basketball (2.4 per 100,000 AE) had the highest rate of dental injury. The most common mechanism of injury was contact with another player (276; 60.4%) followed by contact with apparatus (146; 31.9%). In the majority of dental injuries (308; 75.1%), the athlete was not wearing a mouthguard when the dental injury was sustained. CONCLUSIONS: Dental injuries were a small proportion of all injuries sustained by high school athletes. The majority of dental injuries were sustained when the athlete was not wearing a mouthguard.

Patterns and predictors of concussion symptom presentations in NCAA athletes.

Sport-related concussion (SRC) is a complex injury, and SRCs are notably prevalent among National Collegiate Athletic Association (NCAA) athletes. We analysed SRCs and associated exposure data collected within the NCAA Injury Surveillance Program during 2014-2019. A total of 1,709 SRCs were reported with complete symptom profiles during the study period (Women's sports n = 499; Men's sports n = 1,210). Event type and academic class year most commonly predicted specific symptom presentations among athletes in men's sports, while symptom presentation among athletes in women's sports was most commonly predicted by class year and sport classification. We observed 78 and 69 significant pairwise symptom dependencies in men's and women's sports athletes, respectively; odds of longer symptom resolution time were higher with greater counts of symptoms with strongest cross-domain associations. Our findings highlight several contextual predictors of specific symptom presentations and identify parsimonious symptom subsets that may indicate protracted recovery among men's and women's sports athletes.

Tennis-specific extension of the International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020.

The IOC has proposed standard methods for recording and reporting of data for injury and illness in sport. The IOC consensus statement authors anticipated that sport-specific statements would provide further recommendations. This statement is the tennis-specific extension of the partner IOC statement. The International Tennis Federation Sport Science and Medicine Committee, in collaboration with selected external experts, met in June 2019 to consider athlete health monitoring issues specific to tennis. Once the IOC consensus statement was finalised, the tennis-specific consensus was drafted and agreed on by the members over three iterations. Compared with the IOC consensus statement, the tennis consensus contains tennis-specific information on injury mechanism, mode of onset, injury classification, injury duration, capturing and reporting exposure, reporting risk and study population. Our recommendations apply to able-bodied as well as wheelchair tennis players. Where applicable, specific recommendations are made for wheelchair tennis.

Maternal Knowledge, Attitudes, and Behavioral Intention after Exposure to Injury Prevention Recommendations in the News Media.

INTRODUCTION: Injury prevention recommendations are frequently presented in the media. Parental understanding and response to these recommendations remain uninvestigated. METHODS: A nationally representative sample of 1,081 mothers completed a cross-sectional survey measuring knowledge, attitudes, and behavioral intention after watching/reading video news stories and print articles on two child safety topics. RESULTS: Of the 1,081 respondents, 33% reported hearing little about injury prevention in the media in the past 30 days, and 32% reported never hearing about injury prevention. Nearly one-half (46%) reported the injury prevention studies they had previously read or heard about in the media were confusing to them at least some of the time. The proportion of mothers who recalled the correct key statistic presented in the story varied by safety topic and medium in which the story was presented. A greater proportion of mothers correctly recalled information from the story narrative than the statistics. Mothers also rated the most interesting part of the story differently based on safety topic and medium. A small proportion were not planning to follow the safety recommendations after viewing the news story. CONCLUSIONS: There are gaps in making injury news stories understandable and memorable for mothers in order to encourage behavioral change.

Liposomal Bupivacaine Versus Standard Periarticular Injection in Total Knee Arthroplasty With Regional Anesthesia: A Prospective Randomized Controlled Trial.

BACKGROUND: Liposomal bupivacaine (Exparel) is a long-acting local anesthetic preparation with demonstrated efficacy over placebo in reducing postoperative pain and opioid requirement. Limited comparative efficacy and cost-effectiveness data exist for its use in total knee arthroplasty (TKA) when used in a multimodal, opioid-sparing analgesic and anesthetic approach. We hypothesized that liposomal bupivacaine offers no clinical advantage over our standard of care but carries significant economic impact. METHODS: This is a prospective, randomized, single-blinded, controlled trial comparing liposomal bupivacaine periarticular injection (PAI) to our current approach including conventional bupivacaine PAI, in the setting of regional anesthesia. All adult unilateral TKA patients of the collaborating surgeon were eligible to participate in the study. Patients were randomized 1:1 to either the liposomal bupivacaine protocol or the standard-of-care protocol. All patients received regional anesthesia and standard postoperative analgesia protocols. Patients and all postoperative healthcare providers were blinded to study arm assignment. RESULTS: A total of 59 patients were enrolled per our a priori power calculation after 1 exclusion for randomization error. No significant demographic differences between the study arms were found. There was no statistically significant difference in the primary outcome of number of physical therapy (PT) sessions required to achieve home-going discharge goals (3.0 ± 1.2 vs 3.6 ± 1.3, P = .137), nor in the clinical secondary outcomes. A significant difference in medication charges was found. CONCLUSION: Our study supports earlier literature suggesting no significant clinical benefit of using liposomal bupivacaine over standard of care in TKA and underscores cost-of-care concerns with this agent.

Full Drug-Eluting Stent Jacket: Two-Year Results of a Single-Center Experience With Zilver PTX Stenting for Long Lesions in the Femoropopliteal Arteries.

PURPOSE: To evaluate the 1- and 2-year patency and reintervention rates with the Zilver PTX drug-eluting stent (DES) in long complex femoropopliteal disease. METHODS: A retrospective review was conducted of 89 consecutive patients (mean age 68.7±9.8 years; 86 men) with femoropopliteal occlusive disease (Rutherford category 2-6) treated with the Zilver PTX between December 2012 and December 2013. Mean lesion length for the entire cohort was 24.2±11.3 cm (median 24.0, range 4-48). The patient population was dichotomized into a short lesion (≤20 cm) group (n=41; mean lesion length 13.3±5.6 cm) and the full DES jacket (>20 cm) group (n=48; mean lesion length 33.0±6.5 cm). Primary endpoints were duplex-derived restenosis (peak systolic velocity ratio >2.5), clinically driven reintervention, and major amputation. RESULTS: The incidence of restenosis was lower in the short lesion group at 1 year (19% vs 40% for the longer lesions, p=0.050) and 2 years (39% vs 54%, respectively; p=0.331). The short lesion group had significantly lower rates of reintervention at both 1 year (2% vs 21% in long lesions, p=0.009) and 2 years (12% vs 33%, p=0.019). CONCLUSION: Treatment of femoropopliteal lesions >20 cm with the Zilver PTX appears to be a clinically effective therapy for patients with symptomatic peripheral artery disease. However, there is an increase in restenosis and a need for reintervention that continues to progress up to 2 years.

Stair-related injuries treated in United States emergency departments.

OBJECTIVE: To investigate the characteristics of stair-related injuries among individuals of all ages and estimate national injury frequencies and rates using a representative sample of patients treated in United States emergency departments. METHODS: Data from the National Electronic Injury Surveillance System were analyzed for patients treated for stair-related injuries in United States emergency departments from 1990 through 2012. RESULTS: An estimated 24,760,843 patients were treated in emergency departments for a stair-related injury during the 23-year study period, averaging 1,076,558 patients annually, or 37.8 injuries per 10,000 United States residents. The annual rate of stair-related injuries decreased by 12.6% (p<0.001) during 1990-1996, followed by an increase of 24.0% (p<0.001) during 1996-2012. Although the highest injury rates occurred among younger children and older adults, the majority (67.2%) of emergency department visits for stair-related injuries was by individuals 11-60years old. Most patients were female (62.4%), who also had a higher injury rate (46.5 vs. 29.1 per 10,000) than males. Sprains and strains (32.3%), soft tissue injuries (23.8%), and fractures (19.3%) were the most common types of injury. The body regions most frequently injured were the lower extremities (42.1%) and head/neck (21.6%). Patients ≤10years old experienced more head/neck injuries. Older adult patients more frequently sustained fractures than younger age groups. CONCLUSIONS: Stairs are a common source of injury among individuals of all ages and the frequency and rate of stair-related injuries are increasing. This underscores the need for increased prevention efforts, particularly those related to stair design and construction.

Functional Movement Screening and Injury Rates in High School and Collegiate Runners: A Retrospective Analysis of 3 Prospective Observational Studies.

OBJECTIVE: Determine if the Functional Movement Screening (FMS) can be used to predict injury in high school and collegiate cross-country and track runners. DESIGN: Prospective Observational, Cohort Study, Level of Evidence, 2. SETTING: High schools and colleges in the Central Ohio area. PATIENTS: Inclusion: (1) cross-country or track runners at participating schools; (2) full participation without restrictions; and (3) signed informed assent or consent. Exclusion: (1) Any injury or lower extremity surgery within 30 days; (2) planned limited participation in the upcoming season; or (3) other participation restrictions. INTERVENTIONS: Functional Movement Screening was completed before the start of each season. Injuries were tracked during the regular season. No interventions were made based on FMS score. MAIN OUTCOME MEASURES: Functional Movement Screening scores, including overall, lower extremity, and specific exercises were compared between runners who did and did not sustain an injury using 2 sample t tests. A cutoff FMS score of ≤14 (most common in previous studies), and ≤15 (determined by a receiver operating characteristic curve), were compared using χ tests. RESULTS: One hundred eighty-three runners were enrolled in the study. Overall, 32 (17.5%) runners sustained an injury. Functional Movement Screening score was not accurate in predicting injury for ≤14 (sensitivity: 65.6%; specificity: 39.7%; and area under the curve = 0.501) or ≤15 (sensitivity: 84.4% and specificity: 23.8%). There was no difference in risk of injury for runners with a FMS score of ≤14 (15.5%) and >14 (18.8%) (P = 0.572) or with a FMS score of ≤15 (17.5%) and >15 (17.4%) (P = 0.988). CONCLUSIONS: Functional Movement Screening composite score may not be useful for injury prediction in populations of high school and collegiate runners.

Paediatric emergency department-based carbon monoxide detector intervention: a randomised trial.

BACKGROUND: Although non-fire-related carbon monoxide (CO) poisoning is almost entirely preventable, over 400 people die and 20 000 people are injured each year in the USA from unintentional CO poisoning. Thus, there is a critical need for evidence-based interventions for preventing CO poisoning and increasing the proper use and installation of CO detectors. METHODS: A randomised, controlled trial (Project CODE, a Carbon Monoxide Detector Education intervention) with 2-week and 6-month follow-up home observations was conducted in 299 parents of children aged ≤18 years recruited in the emergency department of a level 1 paediatric trauma centre. The intervention group received an educational tool, a spiral-bound, laminated booklet that resembled a CO detector containing theory-based safety messages based on the precaution adoption process model, a plug-in CO detector and 9 V battery. The control group received a one page flyer on CO poisoning prevention. RESULTS: Although the difference was not statistically significant, mean CO knowledge score increased at a greater rate for the intervention group than the control group. Intervention group parents were more likely to exhibit 'safe' CO detector use than control group parents at the 2-week follow-up (RR: 2.75; 95% CI 2.06 to 3.69) and 6-month follow-up (RR: 2.78; 95% CI 2.06 to 3.76), after adjusting for self-reported CO detector use behaviour at enrolment and annual per capita income. CONCLUSIONS: An emergency department-delivered intervention containing a theory-based educational tool paired with a CO detector can be an effective method for increasing knowledge about CO poisoning, for prevention and for appropriate use of a CO detector. TRIAL REGISTRATION NUMBER: NCT00959478.

Breast Cancer Risk Assessment at the Time of Screening Mammography: Perceptions and Clinical Management Outcomes for Women at High Risk.

The purpose of this study was to evaluate the utility of a breast cancer risk assessment (BCRA) at the time of screening mammogram. Women whose BCRA indicated a high risk for cancer received a letter with instructions for breast health care and genetic counseling if appropriate. After 6 months this group received surveys to evaluate their risk perception and their recall of, and compliance with, recommendations. We also explored the impact of other variables such as a recommendation for genetic counseling and physician communication with the women. After the BCRA, the majority of high risk women reported no change in their perceived risk of cancer. A woman's perceived risk of cancer after a BCRA was significantly associated with her recall of recommendations for breast health care, but not with compliance. A recommendation for genetic counseling was not significantly related to women's perceived risk of cancer after the BCRA. Ten percent of women who should have obtained genetic counseling actually completed an appointment. Women who discussed their BCRA results with their physicians were more compliant with a six month breast exam with a doctor (53% vs 17%, p = 0.018). Overall, women felt that the BCRA was helpful and did not cause undue stress or anxiety. Although the cohort's compliance with recommendations was suboptimal, physicians' interactions with their patients may have a positive influence on their compliance.

Epidemiology of meniscal injuries in US high school athletes between 2007 and 2013.

PURPOSE: Knowledge of epidemiologic trends of meniscal injuries in young active populations is limited. Better awareness of injury patterns is a first step to lowering injury rates. Our hypothesis was that meniscal injuries in high school athletes would vary by gender, sport, and type of exposure. METHODS: During the 2007/2008 and 2012/2013 academic years, a large nationally disperse sample of US high schools reported athlete exposure and injury data for 22 sports by having certified athletic trainers complete an internet-based data collection tool. RESULTS: One thousand and eighty-two meniscal injuries were reported during 21,088,365 athlete exposures for an overall injury rate of 5.1 per 100,000 athlete exposures. The overall rate of injury was higher in competition (11.9) than practice (2.7) (RR = 4.4; 95% CI 3.9-5.0), and 12/19 sports showed significantly higher injury rates in competition compared to practice. Of all injuries, 68.0% occurred in boys, yet among the gender-comparable sports of soccer, basketball, track and field, lacrosse, and baseball/softball injury rates were higher for girls than boys (5.5 and 2.5, respectively, RR = 2.2; 95% CI 1.8-2.7). Contact injury represented the most common mechanism (55.9%). Surgery was performed for the majority of injuries (63.8%), and 54.0% of athletes had associated intra-articular knee pathology. CONCLUSIONS: Meniscal injury patterns among high school athletes vary by gender, sport, and type of exposure. Our study is clinically relevant because recognition of distinct differences in these injury patterns will help drive evidence-based, targeted injury prevention strategies and efforts. LEVEL OF EVIDENCE: III.

Dental injuries sustained by high school athletes in the United States, from 2008/2009 through 2013/2014 academic years.

BACKGROUND/AIM: Risk of dental injuries is present in a variety of sports. Mouthguards are effective yet underutilized. This study aimed to estimate the rate of dental injuries among high school athletes and investigate the utilization of mouthguards across multiple high school sports. MATERIALS AND METHODS: Athlete exposure and dental injury data were collected during the 2008/2009 through 2013/2014 academic years from a large sample of high schools in the United States as part of the National High School Sports-Related Injury Surveillance Study. RESULTS: There were 222 dental injuries sustained during 24,787,258 athlete exposures for a rate of 0.90 per 100,000 athlete exposures. The rate of dental injuries in competition (1.8) was three times higher than the rate in practice (0.6) (RR: 3.1, 95% CI: 2.3-4.0). Rates of dental injuries varied by sport with the highest rates in girls' field hockey (3.9) and boys' basketball (2.6). Dental injuries most commonly occurred as a result of contact with another player (61.3%) and contact with a playing apparatus (31.5%). For the majority of dental injuries, the athlete was not wearing a mouthguard (72.5%). Among injuries where athletes were wearing mouthguards, the majority were self-fitted (95.9%). CONCLUSIONS: Although dental injuries were relatively uncommon, the majority occurred while the athlete was not wearing a mouthguard. As previous studies have shown that mouthguards are effective in preventing injuries, all high school athletes participating in a sport that places them at risk of sustaining a dental injury should wear a mouthguard consistently in both competition and practice.

Epidemiology of overuse injuries among high-school athletes in the United States.

OBJECTIVE: To examine high school overuse injury rates and patterns by sex and sport. STUDY DESIGN: High school athletes participating in the High School Reporting Information Online study were examined in a descriptive epidemiologic study. Overuse injury data for the 2006/2007-2011/2012 academic years collected via High School Reporting Information Online from a large national sample of US high schools where certified athletic trainers completed detailed injury reports were evaluated. RESULTS: From 2006/2007 to 2011/2012, a total of 2834 overuse injuries were reported during 18 889 141 athletic exposures (1.50 per 10 000 athletic exposures). Girls had greater rates of overuse injury (1.88) than boys (1.26) (rate ratio 1.50, 95% CI 1.39-1.61). The greatest rates were in girls' track and field (3.82) and girls' field hockey (2.93). Overuse injuries represented 7.7% of all injuries, ranging from a low of 1.4% of all boys' ice hockey injuries to a high of 55.7% of all boys' swimming and diving injuries. Overall, overuse injuries were evenly distributed across athletes in each year of high school (freshman, 25.6%; sophomore, 25.3%; junior, 24.9%; senior, 24.3%). However, there were distinct differences by sex. The most frequent site of injury was the lower leg (21.8%). Injuries most frequently resulted in time loss of less than 1 week (50.0%), with only 7.6% resulting in time loss greater than 3 weeks. CONCLUSIONS: Overuse injury patterns differed by sex and sport. A better understanding of overuse injury patterns and criteria for return to play may help direct preventative measures and injury management.

Evaluation of a simple test of reaction time for baseline concussion testing in a population of high school athletes.

OBJECTIVE: A common sequela of concussions is impaired reaction time. Computerized neurocognitive tests commonly measure reaction time. A simple clinical test for reaction time has been studied previously in college athletes; whether this test is valid and reliable when assessing younger athletes remains unknown. Our study examines the reliability and validity of this test in a population of high school athletes. DESIGN: Cross-sectional study. SETTING: Two American High Schools. PARTICIPANTS: High school athletes (N = 448) participating in American football or soccer during the academic years 2011 to 2012 and 2012 to 2013. INTERVENTIONS: All study participants completed a computerized baseline neurocognitive assessment that included a measure of reaction time (RT comp), in addition to a clinical measure of reaction time that assessed how far a standard measuring device would fall prior to the athlete catching it (RT clin). MAIN OUTCOME MEASURES: Validity was assessed by determining the correlation between RT clin and RT comp. Reliability was assessed by measuring the intraclass correlation coefficients (ICCs) between the repeated measures of RT clin and RT comp taken 1 year apart. RESULTS: In the first year of study, RT clin and RT comp were positively but weakly correlated (rs = 0.229, P < 0.001). In the second year, there was no significant correlation between RT clin and RT comp (rs = 0.084, P = 0.084). Both RT clin [ICC = 0.608; 95% confidence interval (CI), 0.434-0.728] and RT comp (ICC = 0.691; 95% CI, 0.554-0.786) had marginal reliability. CONCLUSIONS: In a population of high school athletes, RT clin had poor validity when compared with RT comp as a standard. Both RT clin and RT comp had marginal test-retest reliability. Before considering the clinical use of RT clin in the assessment of sport-related concussions sustained by high school athletes, the factors affecting reliability and validity should be investigated further. CLINICAL RELEVANCE: Reaction time impairment commonly results from concussion and is among the most clinically important measures of the condition. The device evaluated in this study has previously been investigated as a reaction time measure in college athletes. This study investigates the clinical generalizability of the device in a younger population. VIDEO ABSTRACT: A video abstract showing how the RT clin device is used in practice is available as Supplemental Digital Content 1, http://links.lww.com/JSM/A43.

Effect of Osteogenic Progenitor Cell Concentration on the Incidence of Foot and Ankle Fusion.

The use of biologics, namely demineralized bone matrix, bone marrow aspirate (BMA), and other growth factors, has gained popularity in foot and ankle surgery for use in compromised hosts or high-risk situations. Our research has shown the concentration of these pluripotent cells was greatest in the iliac crest. A medical record and radiographic review was performed to compare the effect of BMA harvest site osteogenic progenitor cells on the incidence of fusion. Radiographs were reviewed for radiographic evidence of trabecular bridging in 2 or more views. If fusion occurred, the number of osteogenic progenitor cells found in the combined BMA at surgery was recorded. A total of 33 patients were included in the present study. Of the 33 patients, 32 (97.0%) had radiographic fusion at a mean of 13 ± 6 (range 8 to 30) weeks, and 1 (3.0%) experienced nonunion and required revision. The patient procedures were as follows: 18 (54.5%) hindfoot arthrodeses, 8 (24.2%) forefoot arthrodeses, 4 (12.1%) fractures, and 3 (9.1%) isolated ankle fusions. The mean colony-forming units for the patients with fusion was 20.3 ± 23.5 (range 0.0 to 107.0). In the patient with nonunion, it was 0.20 colony-forming unit. Our comparison of the incidence of fusion with the use of osteogenic progenitor cells from 3 anatomic sites showed a low incidence of complications and a high incidence of fusion. No association was found between the BMA concentration and the incidence of fusion, suggesting a minimum concentration and biologic potential of pluripotent cells is necessary to achieve the clinical effect of fusion.

Mouthguard BITES (behavior, impulsivity, theory evaluation study): what drives mouthguard use among high school basketball and baseball/softball athletes.

Although mouthguards are effective, inexpensive, easy to use, and readily available, this form of protective equipment has been underutilized. "Impulsive delay discounting" (an index of impulsive behavior) among high school athletes may help explain their decision making regarding use of protective equipment such as mouthguards. We investigated the relationship between high school baseball, softball, and basketball players' mouthguard use, impulsive delay discounting, and the precaution adoption process model (a behavior change theory). A convenience sample of boys' and girls' basketball and baseball/softball players at 21 high schools in the Greater Columbus, Ohio, metro area completed a self-administered survey that captured their demographic information, knowledge, attitudes, and beliefs regarding mouthguard use, impulsive delay discounting, and precaution adoption process model stage. We surveyed a total of 1636 students (55.9 % male, 43.8 % female, 0.3 % unknown). Only 12.3 % reported using a mouthguard either every time or sometimes during practice or competition. The primary reasons reported for not wearing mouthguards were they were not required to (65.3 %) and that the athletes could not breathe or talk while wearing one (61.5 %). These reasons were consistent across sex and sport. Most athletes reported that their coaches (87.3 %) and parents (64.5 %) had never talked to them about wearing a mouthguard. Lower precaution adoption process model stage was significantly associated with higher impulsivity (p < 0.001) and higher delayed discounting (p = 0.016) after adjusting for school, sport, and sex. Voluntary mouthguard use among high school athletes playing basketball and baseball/softball remains low despite the risk of dental injury in these sports. Effective, evidence-based, targeted, and tailored interventions to improve adolescent athletes' use of mouthguards to prevent sports-related dental injuries should be based on the specific behavioral and social factors influencing each athlete's decision making regarding use of mouthguards.

Neck strength: a protective factor reducing risk for concussion in high school sports.

As the number of high school students participating in athletics continues to increase, so will the number of sports-related concussions unless effective concussion prevention programs are developed. We sought to develop and validate a cost-effective tool to measure neck strength in a high school setting, conduct a feasibility study to determine if the developed tool could be reliably applied by certified athletic trainers (ATs) in a high school setting, and conduct a pilot study to determine if anthropometric measurements captured by ATs can predict concussion risk. In the study's first phase, 16 adult subjects underwent repeated neck strength testing by a group of five ATs to validate the developed hand-held tension scale, a cost effective alternative to a hand-held dynamometer. In the second phase, during the 2010 and 2011 academic years, ATs from 51 high schools in 25 states captured pre-season anthropometric measurements for 6,704 high school athletes in boys' and girls' soccer, basketball, and lacrosse, as well as reported concussion incidence and athletic exposure data. We found high correlations between neck strength measurements taken with the developed tool and a hand-held dynamometer and the measurements taken by five ATs. Smaller mean neck circumference, smaller mean neck to head circumference ratio, and weaker mean overall neck strength were significantly associated with concussion. Overall neck strength (p < 0.001), gender (p < 0.001), and sport (p = 0.007) were significant predictors of concussions in unadjusted models. After adjusting for gender and sport, overall neck strength remained a significant predictor of concussion (p = 0.004). For every one pound increase in neck strength, odds of concussion decreased by 5 % (OR = 0.95, 95 % CI 0.92-0.98). We conclude that identifying differences in overall neck strength may be useful in developing a screening tool to determine which high school athletes are at higher risk of concussion. Once identified, these athletes could be targeted for concussion prevention programs.

Epidemiology of Anterior Cruciate Ligament Tears in National Collegiate Athletic Association Athletes: 2014/2015-2018/2019.

PURPOSE: This study aimed to describe the epidemiology of ACL tears in NCAA men's and women's sports. METHODS: Injury and exposure data collected within the NCAA Injury Surveillance Program from 2014/2015 to 2018/2019 were analyzed. ACL tear frequencies, injury rates (IR), and injury proportions were used to describe injury incidence by sport, event type, injury mechanism, and injury history. Injury rate ratios (IRR) were used to examine differential injury rates, and injury proportion ratios (IPR) were used to examine differential distributions. RESULTS: A total of 729 ACL tears were reported from 8,474,401 recorded athlete exposures (AE) during the study period (IR = 0.86 per 10,000 AE), and the competition-related ACL tear rate was higher than the practice-related rate (IRR = 5.52, 95% confidence interval [CI] = 4.75-6.39). Among men's sports, the highest overall ACL tear rate was observed in men's football (IR = 1.44 per 10,000 AE), whereas among women's sports, the highest overall rate was observed in women's soccer (IR = 2.60 per 10,000 AE). Among sex-comparable sports, ACL tear rates were higher in women's basketball, softball, and soccer, as compared with their men's counterparts. ACL tears were more prevalently attributed to player contact mechanisms in men's sports than women's sports (IPR = 1.73, 95% CI = 1.37-2.19), but more prevalently attributed to noncontact mechanisms in women's sports than men's sports (IPR = 1.17, 95% CI = 1.01-1.35). CONCLUSIONS: ACL tear risk in women's sports continues to warrant attention and prevention efforts. Given the differential rates by event type, future research efforts may also evaluate initiatives to reduce competition-related injury burden in NCAA sports.