High Return to Play and Low Reinjury Rates in National Collegiate Athletic Association Division I Football Players Following Anterior Cruciate Ligament Reconstruction Using Quadrupled Hamstring Autograft.

PURPOSE: The purpose of this study was to examine the outcomes of anterior cruciate ligament (ACL) reconstruction using quadrupled hamstring (QH) autograft in a cohort of National Collegiate Athletic Association (NCAA) Division I football players. METHODS: A retrospective analysis was performed on NCAA Division I football players at a single institution who had transtibial ACL reconstruction using QH autograft between 2001 and 2016. Primary outcomes were ACL reinjury and return to play (RTP). Secondary outcomes were position, percent of eligibility used after surgery, graft diameter, Tegner-Lysholm scores, concomitant injuries/surgeries, and postcollegiate professional play. RESULTS: Between 2001 and 2016, 34 players had QH autograft ACL reconstruction, and 29 players achieved RTP. Of the 29, 2 (6.9%) sustained ACL reinjuries. The average RTP was 318 days (range 115-628) after surgery. Players used 79.5% of their remaining collegiate eligibility after surgery. Nine players sustained multiligamentous knee injuries. This did not have a significant effect on RTP (P = 0.709; mean 306±24 days for isolated ACL, mean of 353±51 for 2 ligaments, mean of 324±114 for 3 + ligaments) and none sustained reinjury. Associated meniscal injuries were sustained by 28, and 8 sustained chondral injuries. The mean postoperative Tegner-Lysholm score was 90.7 of 100, with mean follow-up of 102 months. Of these players, 18 went on to play professionally, with 17 joining National Football League rosters and 1 an arena team roster. CONCLUSION: QH demonstrated an ACL reinjury and RTP rates similar to those in previously published, predominantly bone-patella tendon-bone ACL reinjury data in elite athletes. This study demonstrates that QH autograft may be a viable option in elite athletes. LEVEL OF EVIDENCE: IV, case series.

Positional Differences in Pre-Season Scrimmage Performance of Division I Collegiate Football Players.

This study aimed to describe the physical demands of American football players using novel performance analysis techniques. Heart rate (HR) and accelerometer-based activity levels were observed across two pre-season scrimmages in 23 Division I collegiate football players (age: 19 ± 1 y, height: 1.90 ± 0.06 m, weight: 116.2 ± 19.4 kg). Data were analyzed using a MATLAB program and inter-rater reproducibility assessed using inter-class correlations (ICC). Players were analyzed by side (offense/defense) and position (skill/non-skill). Performance variables assessed in bursts of activity included burst duration, HRmean and HRmax (bpm), and mean activity (vector magnitude units [vmu]). Exercise intensity was categorized as time spent in % HRmax in 5% increments. The burst duration (8.1±3.9 min, ICC = 0.72), HRmean (157 ± 12 bpm, ICC = 0.96) and mean activity (0.30 ± 0.05 vmu, ICC = 0.86) were reproducible. HRmean (p = 0.05) and HRmax (p = 0.001) were greater on defense. Offense spent more time at 65-70% HRmax (p = 0.01), 70-75% HRmax (p = 0.02) while defense spent more time 90-95% HRmax and ≥95% HRmax (p = 0.03). HRmean (p = 0.70) and HRpeak (p = 0.80) were not different between positions across both sides. Skilled players demonstrated greater mean activity (p = 0.02). The sport-specific analysis described HR and activity level in a reproducible manner. Automated methods of assessing HR may be useful in training and game time performance but ultimately provides support to coaching decision making.

Effects of Field Position on Fluid Balance and Electrolyte Losses in Collegiate Women's Soccer Players.

Research investigating hydration strategies specialized for women's soccer players is limited, despite the growth in the sport. The purpose of this study was to determine the effects of fluid balance and electrolyte losses in collegiate women's soccer players. Eighteen NCAA Division I women's soccer players were recruited (age: 19.2 ± 1.0 yr; weight: 68.5 ± 9.0 kg, and height: 168.4 ± 6.7 cm; mean ± SD), including: 3 forwards (FW), 7 mid-fielders (MD), 5 defenders (DF), and 3 goalkeepers (GK). Players practiced outdoor during spring off-season training camp for a total 14 practices (WBGT: 18.3 ± 3.1 °C). The main outcome measures included body mass change (BMC), sweat rate, urine and sweat electrolyte concentrations, and fluid intake. Results were analyzed for comparison between low (LOW; 16.2 ± 2.6° C, n = 7) and moderate risk environments for hyperthermia (MOD; 20.5 ± 1.5 °C, n = 7) as well as by field position. The majority (54%) of players were in a hypohydrated state prior to practice. Overall, 26.7% of players had a %BMC greater than 0%, 71.4% of players had a %BMC less than -2%, and 1.9% of players had a %BMC greater than -2% (all MD position). Mean %BMC and sweat rate in all environmental conditions were -0.4 ± 0.4 kg (-0.5 ± 0.6% body mass) and 1.03 ± 0.21 mg·cm-2·min-1, respectively. In the MOD environment, players exhibited a greater sweat rate (1.07 ± 0.22 mg·cm-2·min-1) compared to LOW (0.99 ± 0.22 mg·cm-2·min-1; p = 0.02). By position, DF had a greater total fluid intake and a lower %BMC compared to FW, MD, and GK (all p < 0.001). FW had a greater sweat sodium (Na+) (51.4 ± 9.8 mmol·L-1), whereas GK had the lowest sweat sodium (Na+) (30.9 ± 3.9 mmol·L-1). Hydration strategies should target pre-practice to ensure players are adequately hydrated. Environments deemed to be of moderate risk of hyperthermia significantly elevated the sweat rate but did not influence fluid intake and hydration status compared to low-risk environments. Given the differences in fluid balance and sweat responses, recommendations should be issued relative to soccer position.

Blood and MRI biomarkers of mild traumatic brain injury in non-concussed collegiate football players.

Football has one of the highest incidence rates of mild traumatic brain injury (mTBI) among contact sports; however, the effects of repeated sub-concussive head impacts on brain structure and function remain under-studied. We assessed the association between biomarkers of mTBI and structural and functional MRI scans over an entire season among non-concussed NCAA Division I linemen and non-linemen. Concentrations of S100B, GFAP, BDNF, NFL, and NSE were assessed in 48 collegiate football players (32 linemen; 16 non-linemen) before the start of pre-season training (pre-camp), at the end of pre-season training (pre-season), and at the end of the competitive season (post-season). Changes in brain structure and function were assessed in a sub-sample of 11 linemen and 6 non-linemen using structural and functional MRI during the execution of Stroop and attention network tasks. S100B, GFAP and BDNF concentrations were increased at post-season compared to pre-camp in linemen. White matter hyperintensities increased in linemen during pre-season camp training compared to pre-camp. This study showed that the effects of repeated head impacts are detectable in the blood of elite level non-concussed collegiate football players exposed to low-moderate impacts to the heads, which correlated with some neurological outcomes without translating to clinically-relevant changes in brain anatomy or function.

Seasonal changes in physiological and psychological parameters of stress in collegiate swimmers.

To investigate the seasonal changes in physiological and psychological parameters of stress in collegiate swimmers. Fifteen NCAA Division I swimmers (8 men) participated in a tethered anaerobic swim test to determine physiological responses in an ecologically-relevant, graded exercise test. Wisconsin Upper Respiratory Symptom Survey (WURSS-21), Activation-Deactivation Adjective Check List (AD-ACL), Daily Analysis of Life Demands of Athletes (DALDA), and Pittsburgh Sleep Quality Index were assessed at post-season in April (V1), the end of off-season in June (V2), and pre-season in October (V3). The percent change was determined from V2-V1 (off-season phase), V3-V2 (pre-season phase), V1-V3 (in-season phase). Spearman's rho correlation was used to examine associations between change in physiological and psychological outcomes. All data results showed a better swim performance occurred at V2. Men tended to have faster speed (p = 0.07) in fewer strokes (p = 0.10) and greater work per stroke (p = 0.10) at V2 than V1. Women were faster during V2 compared to V1 (p = 0.02) and V3 (p = 0.05). Women had fewer strokes (p = 0.02) and greater work per stroke (p = 0.01) at V2 compared to V3. Women had the lowest HR and lactate concentration at V3 compared to other visits (p < 0.05). During the in-season phase, swim speed decreased the greatest extent and stress sources and symptoms assessed by DALDA had greatest elevation (p < 0.05). An increased in stress sources and symptoms assessed by DALDA was associated with an increase in upper respiratory illness from WURSS-21 (rho = 0.44, p = 0.009), being less energetic (rho = - 0.35, p = 0.04) and greater tension state (rho = 0.49, p = 0.003; AD-ACL), and a decrease in swim speed (rho =- 0.38, p = 0.03). Swim performance peaked at off-season when psychological stress was at its lowest. The relationship between DALDA scores with psychological parameters and swim performance suggested physiological and psychological parameters of stress is an important aspect to avoid overtraining when approaching high swim performance.

Salivary immunity of elite collegiate American football players infected with SARS-CoV-2 normalizes following isolation.

The impact of COVID-19 on systemic immunity in the general population has been well characterized, however the short-term effects of COVID-19 infection on innate salivary immunity in elite-level athletes are unknown. Therefore, this study aimed to determine whether elite college football athletes had altered salivary immunity following the CDC-recommended isolation post-SARS-CoV-2 infection. Salivary samples were obtained from fourteen elite football players who tested positive for SARS-CoV-2 (n = 14), immediately after CDC-recommended isolation (average days = 14 ± 2 days) and fifteen controls who remained uninfected with SARS-CoV-2. Biomarkers of innate salivary immunity (sIgA and alpha-amylase), antimicrobial proteins (AMPs, i.e., HNP1-3, lactoferrin, LL-37) and lung inflammation (SPA, SPLI, and Neutrophil Elastase-alpha-1-antitrypsin complex) were measured. Independent student t-tests were used to determine changes in biomarkers between groups. Although all AMP levels were within normal range, Human Neutrophil Defensin 1-3 concentrations and secretion rates were higher in SARS-CoV-2+ compared to SARS-CoV-2-. This suggests that the CDC-recommended isolation period is sufficient to ensure that athletes' salivary immunity is not compromised upon return to sports, and athletes post-COVID-19 infection do not appear to be at greater risk for secondary infection than those with no history of COVID-19.

NCAA Division I American football players with sickle cell trait have altered hematological responses and hydration status.

Sickle cell trait (SCT) is a risk factor of collapse and sudden death in athletes. We conducted a longitudinal study to determine the hematological responses and hydration status in NCAA Division I American football players with SCT. The study took place over 2 years with 6 SCT and 6 position-matched controls (CON) in year 1; and 4 SCT and 4 CON in year 2. In year 2, three of the four SCT players were recruited and re-enrolled with new position-matched controls (total sample data = 10 SCT and 10 CON). Blood samples were taken at three visits: pre-camp, post-camp, and post-season to examine hemoglobin variants, complete blood counts, and chemistry panel 26. Hydration status was assessed by measuring body weight change, urine specific gravity, and urine and sweat electrolyte concentrations during the pre-season training camp. All SCT players were confirmed to have SCT (HbS = 37.9 ± 2.4%) and had greater red cell distribution width (RDW) compared to CON across all visits. Serum uric acid was higher in SCT (7.3 ± 1.0 mg/dL) compared to CON (6.1 ± 0.6 mg/dL; p = 0.001). Furthermore, serum creatine kinase levels were greater in SCT (1617.0 ± 1034.8 IU/L) at pre-camp compared to CON (1037.4 ± 602.8 IU/L; p = 0.03). SCT players exhibited lower pre- and post-practice urine electrolytes and urine specific gravity (SCT pre: 1.019 ± 0.005 vs. CON pre: 1.026 ± 0.008 p < 0.001; SCT post: 1.020 ± 0.005 vs. CON post: 1.030 ± 0.008 p < 0.01), whereas sweat sodium concentrations were higher in SCT players (55.4 ± 13.6 mmol/L) compared to CON (45.5 ± 10.6 mmol/L; p < 0.001). Given the evidence, greater uric acid and CPK levels in SCT players compared to CON may be an early indicator of altered kidney function and muscle damage, which could be added into NCAA guidelines for surveillance among SCT players. Consistent education and reinforcement of the importance of adequate fluid balance during exercise are critical for both SCT and CON players.

Allostatic stress load and CMV serostatus impact immune response to maximal exercise in collegiate swimmers.

Collegiate athletes are exposed to varying levels of academic and physical stressors, placing them at increased risk for stress-activated latent viral infections. However, the impact of allostatic stress load on the immune response to maximal exercise in athletes remains largely unknown. This study examined the effects of a 7-mo training period and cytomegalovirus (CMV) serostatus on immune cell response to high-intensity swim tests within a group of collegiate swimmers. Samples were collected from 15 National Collegiate Athletic Association Division I swimmers (9 men, 6 women: 19.87 ± 0.64 yr) before and after exhaustive in-pool swims at 2 time points (V1: immediately post-season 1 and V3: beginning of season 2). An additional off-season (V2) time point was collected in a subset of 9 swimmers. Natural killer (NK) cell, B cell, and T cells were quantified by flow cytometry. Linear mixed models were used to determine the effects of exercise, time point, and CMV serostatus (α = 0.05). Resting senescent CD8+ T cells were higher in CMV-seropositive participants at V3 (P = 0.005). CMV-seronegative participants had a decrease in resting senescent CD8+ T cells from V1 to V3 (P = 0.021). After acute exercise, CMV-seropositive participants had lower naïve CD8+ T cells (P < 0.001) and higher senescent CD8+ T cells (P < 0.001). Increased cumulative stress levels did not appear to affect B-cell and NK-cell compartments. Immune response to exercise was impacted by CMV serostatus and allostatic stress load. Young CMV-seropositive athletes exposed to elevated stressors should be monitored to determine long-term effects of training and academic stressors.NEW & NOTEWORTHY Allostatic stress load is associated with impaired immune response to maximal exercise in cytomegalovirus (CMV)-seropositive subjects but not in CMV-seronegative young healthy adults.