Validity of Research Based on Public Data in Sports Medicine: A Quantitative Assessment of Anterior Cruciate Ligament Injuries in the National Football League.

BACKGROUND: Numerous researchers have leveraged publicly available Internet sources to publish publicly obtained data (POD) studies concerning various orthopaedic injuries in National Football League (NFL) players. PURPOSE: To provide a comprehensive systematic review of all POD studies regarding musculoskeletal injuries in NFL athletes and to use anterior cruciate ligament (ACL) injuries in NFL players to quantify the percentage of injuries identified by these studies. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic review was conducted to identify all published studies utilizing POD regarding ACL injury in NFL athletes from 2000 to 2019. Data regarding player demographics were extracted from each publication. These results were compared with prospectively collected data reported by the teams' medical staff to the NFL Injury Surveillance System database linked to the League's electronic health record. An ACL "capture rate" for each article was calculated by dividing the number of ACL injuries in the POD study by the total number of ACL injuries in the NFL injury database occurring in the study period of interest. RESULTS: A total of 42 studies were extracted that met the definition of a POD study: 28 evaluated a variety of injuries and 14 dealt specifically with ACL injuries, with 35 (83%) of the 42 studies published during or since 2015. POD studies captured a mean of 66% (range, 31%-90%) of ACL injuries reported by the teams' medical staff. This inability to capture all injury rates varied by position, with 86% capture of ACL injuries in skill athletes, 72% in midskill athletes, and 61% in linemen. POD studies captured 35% of injuries occurring during special teams play. CONCLUSION: The frequency of studies leveraging publicly obtained injury data in NFL players has rapidly increased since 2000. There is significant heterogeneity in the degree to which POD studies correctly identify ACL injuries from public reports. Sports medicine research relying solely on publicly obtained sources should be interpreted with an understanding of their inherent limitations and biases. These studies underreport the true incidence of injuries, with a bias toward capturing injuries in more popular players.

Krackow locking stitch versus locking premanufactured loop stitch for soft-tissue fixation: a biomechanical study.

PURPOSE: To biomechanically compare construct elongation under loading conditions and to compare load to failure for the locking premanufactured loop stitch versus the Krackow stitch. METHODS: Twenty porcine Achilles tendons were randomly assigned to receive the locking Krackow stitch with No. 2 FiberWire (Arthrex, Naples, FL) or the locking premanufactured loop stitch with No. 2 FiberLoop (SpeedWhip; Arthrex). Each tendon was pre-tensioned 3 times at 100 mm/min to 100 N for removal of slack, preloaded to 50 N to simulate tension applied clinically, and cyclically loaded at 200 mm/min to 200 N for 200 cycles. Total elongation of both suture strands was measured at each stage. Each tendon was loaded to failure. RESULTS: Elongation (mean ± standard deviation) in the Krackow group and the SpeedWhip group did not differ with initial loading at 50 N (4.5 ± 1.0 mm and 5.0 ± 1.7 mm, respectively; P = .4) or with cyclic loading (15.6 ± 5.7 mm and 17.0 ± 2.6 mm, respectively; P = .5). Load to failure was significantly higher in the SpeedWhip group as compared with the Krackow group (344.0 ± 23.1 N and 301.3 ± 24.4 N, respectively; P = .001). CONCLUSIONS: In a porcine tendon model, the locking loop stitch group was not significantly different regarding construct elongation with initial or cyclic loading compared with the Krackow stitch group. These findings suggest that the locking loop stitch has adequate strength to serve as an alternative to the Krackow stitch in procedures where the Krackow stitch is used. The elongation data suggest that augmentation or protection with early stress postoperatively would be needed with the locking loop stitch as with the Krackow stitch clinically. CLINICAL RELEVANCE: Similar elongation in the 2 constructs suggests that this locking loop stitch has adequate strength to serve as an alternative to the Krackow stitch in procedures where the Krackow stitch is used.

Descriptive epidemiology of collegiate women's lacrosse injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004.

OBJECTIVE: To review 16 years of National Collegiate Athletic Association injury surveillance data for women's lacrosse and identify potential areas for injury prevention initiatives. BACKGROUND: Women's lacrosse is a fast-paced, primarily noncontact sport. Participation in collegiate women's lacrosse almost doubled between the 1988-1989 and 2003-2004 seasons. Lacrosse equipment consists of sticks made of wood or a synthetic material and a hard rubber ball. Until recently, mouth guards were the only required protective equipment. MAIN RESULTS: Collegiate women's lacrosse game injury rates increased over the 16-year study period. More than 60% of all severe game injuries were lower extremity sprains and strains and knee internal derangements, most frequently the result of noncontact incidents. The most common injury scenarios by injury mechanism and player activity were no contact while ball handling (16.4%) and contact from a stick while ball handling (10.5%). Contact from a stick or a ball accounted for 5.6% and 5.2% of injuries sustained during shooting activities, respectively. Approximately 22% of all game and 12% of all practice injuries involved the head and neck. Contact from a stick accounted for the majority (56.0%) of above-the-neck injuries in games; contact from the ball accounted for 20.0% of these injuries. Participants had 5 times the risk of sustaining a concussion in a game as in a practice (0.70 versus 0.15 injuries per 1000 athletic-exposures, rate ratio = 4.7, 95% confidence interval = 3.8, 6.5). RECOMMENDATIONS: To reduce the lower extremity injuries that comprise the greatest injury burden in women's lacrosse, future researchers should evaluate proprioceptive, plyometric, and balance training interventions designed specifically for female players. Other research areas of great interest involve determining whether protective eyewear (mandated in 2004) reduces injuries to the eye, orbit, and nasal area and identifying any unintended consequences of the mandate, such as increased risk of injuries to other areas of the face or more aggressive play.