History of biological, mechanistic, and clinical understanding of concussion.

The history behind the biological, mechanistic, and clinical insights into concussion provides awareness of the current understanding and future areas for study. Although the initial description of concussion appeared in the 10th century, the potential long-term structural consequences were first defined by Harrison Martland, M.D., who performed a postmortem study of former boxers in 1928. He found evidence of perivascular microhemorrhage that he believed eventually evolved into a "replacement gliosis" underlying a clinical syndrome that he named "punch drunk," which was characterized by acute confusion with chronic cognitive and physical symptoms developing in those with prolonged exposure. Further research into the potential long-term consequences of repetitive concussions, particularly in athletics and the military, led to an understanding of chronic traumatic encephalopathy. To ameliorate possible long-term risks, research has been focused on preventative and therapeutic measures for concussion. In this review article, the authors present the history of concussion and the long-term sequelae of repeated head injury. Specifically, they consider how the understanding of concussion has evolved from antiquity into the modern era, and how this change in understanding of head injury has led to an appreciation of the fact that its long-term implications sometimes manifest as the clinical and histopathological entity of chronic traumatic encephalopathy.

History of Chronic Traumatic Encephalopathy.

The long-term effects of repetitive head impacts have been recognized for close to a century. What is now referred to as chronic traumatic encephalopathy (CTE) was first described by Martland in 1928 in a series of boxers. Over the years, several important articles were published, including Critchley's 1957 report where he introduced the term "chronic traumatic encephalopathy," Robert's study in 1969 which provided evidence of the prevalence of neurological impairment in retired fighters, and Corsellis' initial description of the pathology of CTE. However, what brought public attention to the issue of CTE in sports were the postmortem findings of CTE pathology in professional American football players, initially reported by Omalu and subsequently in a large series by McKee. There is now standardization of pathological criteria for CTE and recognition that it can be seen across all activities that involve repetitive head impacts.

Concussion, Cagney, Captains of the Clouds.

The case of James Cagney adds interesting details to the history of concussion. It is underappreciated that a movie-star of Cagney's stature incurred multiple concussions over many years. Moreover, the fact that he sustained one of these concussions in Canada while filming Captains of the Clouds, a major Hollywood film, is essentially unknown, and was seldom discussed by Cagney despite his willingness to discuss his many other concussions. The scene showing this concussion was left in the final released version of the movie, making it one of the earliest filmed concussions and the first concussion ever filmed in Technicolor.

Injuries in the Greek epics of Homer.

Trauma and the need of medical care exist since the beginning of human history. This research is aimed to identify and analyze trauma in antiquity. After a review of bibliography, the first reports of trauma (in Europe) were found in the Greek Epics of Homer. The analysis of these texts showed that injury could be caused to any part of the human body. The main cause of trauma was primarily participation in wars (178 cases), and then participation in sports (6 cases) and other activities (6 cases). This study identified a total of 190 injuries in both Homer epics. The more serious injuries, many of which proved fatal, were observed from participation in military activities.

Horse-riding accidents and injuries in historical records of Joseon Dynasty, Korea.

Only a few osteological reports describe bone injuries thought to have been caused by falls from horses. Nevertheless, anthropological study alone is insufficient for establishing the correlates of such equestrian accidents. We therefore reviewed the records in Seungjeongwon ilgi (Diaries of the Royal Secretariat) and Joseon wangjo silrok (Annals of the Joseon Dynasty) of the Korea's Joseon period (1392-1910 CE). Although the mechanisms of trauma were diverse, the Joseon documents recorded many injuries caused by horse-riding accidents. During 1625-1872 CE, equestrian-related accidents occurred almost every year, overwhelming other causes of trauma. In all horse-riding accidents (n=142), 37.77% of the records offer detailed data about the traumatic mechanism. Injuries occurred most frequently to the extremities (79.58%), which were followed by the trunk (34.5%) and head (4.92%). Although we do not think that this attempt can explain every paleopathological case, our historical review shows that equestrian-related injuries could be considered as one of the major causes for the bone trauma observed among ancient equestrian people.

Epidemiology and history of knee injury and its impact on activity limitation among football premier league professional referees.

BACKGROUND: The purpose of this study was to determine the epidemiology and history of knee injury and its impact on activity limitation among football premier league professional referees in Iran. METHODS: This was a descriptive study. 59 Football Premier League professional referees participated in the study. The knee injury related information such as injury history and mechanism was recorded. Injury related symptoms and their impacts on the activity limitation, ability to perform activities of daily living as well participation in sports and recreational activities was obtained through the Knee Outcome Survey (KOS). RESULTS: The results indicated that 31 out of 59 participants reported the history of knee injury. In addition, 18.6%, 22.4% and 81% of the referees reported that they had been injured during the last 6 months of the last year, and at some point in their refereeing careers, respectively. Results further indicated that 48.8% of the injuries occurred in the non-dominant leg and they occurred more frequently during training sessions (52%). Furthermore, the value of KOS was 85 ± 13 for Activities of Daily Living subscale and 90 ± 9 for Sports and Recreational Activities subscale of the KOS. CONCLUSIONS: Knee injury was quite common among the Football Premier League professional referees. It was also indicated that the injuries occurred mainly due to insufficient physical fitness. Therefore, it is suggested that football referees undergo the proper warm-up program to avoid knee injury.

Terapia celular en las lesiones deportivas: dónde estamos y a dónde vamos / Cell therapy in sports injuries: Where we are and where we're headed

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The Evolution of the Surgical Treatment of Sports Injuries in the 20th Century: A Historical Perspective.

Sports injuries have been a major issue in medicine, surgery, and especially in orthopedics since the classical antiquity era. The 20th century, with its progress and innovations, changed the general concept of treating these injuries forever. The purpose of this review is to show how innovations in surgery in the 20th century changed the rationale of treating sports injuries. In this historical review, we present innovations concerning fracture treatment, spine injury treatment, and anterior cruciate ligament reconstruction related to sports injuries. In addition, we present and record those surgical techniques and the pioneer surgeons who first used them.

A Historical Perspective on Sports Concussion: Where We Have Been and Where We Are Going.

The approach to sports concussion diagnosis and management has been evolving at an unprecedented rate over the last several years. So much so, that committees at all level of sports have implemented concussion protocols and made adjustments to certain league rules in an effort to minimize the risk of head injury. With this newfound attention has come an even greater push by the scientific community to address the many questions that remain. The aim of this review article is to present the topic of sports concussion by means of discreet eras. It begins by introducing the very first mentions of concussion, dating back to ancient Greece, to present day, highlighting important periods along the way. It then goes on to review emerging scientific data, from biomarkers and serum studies, to imaging modalities, and brain networking. All of which will hopefully contribute to both the diagnostic and therapeutic approach to sports concussion.

The last ride of Henry II of France: orbital injury and a king's demise.

Jousting was a popular pastime for royalty in the Renaissance era. Injuries were common, and the eye was particularly at risk from the splinters of the wooden lance. On June 30, 1559, Henry II of France participated in a jousting tournament to celebrate two royal weddings. In the third match, Gabriel de Montgomery struck Henry on the right shoulder and the lance splintered, sending wooden shards into his face and right orbit. Despite being cared for by the prominent physicians Ambroise Paré and Andreas Vesalius, the king died 10 days later and was found to have a cerebral abscess. The wound was not explored immediately after the injury; nevertheless, wooden foreign bodies were discovered in the orbit at the time of autopsy. The dura had not been violated, suggesting that an infection may have traveled from the orbit into the brain. Nostradamus and Luca Guarico, the astrologer to the Medici family, had prophesied the death of Henry II of France, but he ignored their warnings and thus changed the course of history in Renaissance Europe.

History of neuropsychological study of sport-related concussion.

Although the medical literature has a long history of description and comment on concussion, the occurrence of concussion within the context of sports other than boxing was not judged to be problematic until the 1980s. Neuropsychological assessment played a critical and integral role in identifying the cognitive sequelae of concussion and mapping out the short- and long-term vagaries in recovery. This paper captures that history and expands upon current applications of neuropsychological assessment in the diagnosis and management of sport-related concussion.

Chronic traumatic encephalopathy in professional sports: retrospective and prospective views.

PRIMARY OBJECTIVE: The purposes of this paper are to review: (1) the history of chronic traumatic encephalopathy (CTE) in sports, (2) the similarities and differences between historic and current definitions of CTE, (3) recent epidemiology and cohort studies of CTE and (4) controversies regarding the current CTE positions. RESEARCH DESIGN: Not applicable. METHODS AND PROCEDURES: Selective review of published articles relevant to CTE. MAIN OUTCOME AND RESULTS: The current definitions of CTE have evolved from its original definition and now rely heavily on the post-mortem detection of hyperphosphorylated tau for diagnosis. As of 2013, there is a blended cohort of 110 professional athletes diagnosed with CTE. It is being assumed that concussions and/or sub-concussive impacts in contact sports are the sole cause of CTE. CONCLUSIONS: There are multiple causes of abnormal tau protein deposition in the human brain and the pathogenesis of CTE may not be related solely to concussion and/or sub-concussive injury. In all likelihood, the causes of CTE are a multivariate, as opposed to a univariate, phenomenon.

Chronic traumatic encephalopathy and the availability cascade.

Chronic traumatic encephalopathy (CTE) in sports has been known for > 85 years, and has experienced a resurgence of interest over the past decade, both in the media and in the scientific community. However, there appears to be a disconnection between the public's perception of CTE and the currently available scientific data. The cognitive bias known as the "availability cascade" has been suggested as a reason to explain this rift in knowledge. This review summarizes and updates the history of CTE in sports, discusses recent epidemiological and autopsy studies, summarizes the evidence base related to CTE in sports, and offers recommendations for future directions.

The history of neurosurgical treatment of sports concussion.

Concussion has a long and interesting history spanning at least the 5 millennia of written medical record and closely mirrors the development of surgery and neurosurgery. Not surprisingly, much of the past and present experimental head injury and concussion work has been performed within neurosurgically driven laboratories or by several surgically oriented neurologists. This historical review chronicles the key aspects of neurosurgical involvement in sports concussion as related to the diagnosis, treatment, mitigation, and prevention of injury using the example of American football. In addition, we briefly trace the developments that led to our current understanding of the biomechanical and neurophysiological basis of concussion.

Assessment, management and knowledge of sport-related concussion: systematic review.

BACKGROUND: Sport-related concussions are a subset of mild traumatic brain injuries and are a concern for many sporting activities worldwide. OBJECTIVE: To review and update the literature in regard to the history, pathophysiology, recognition, assessment, management and knowledge of concussion. METHODS: Searches of electronic literature databases were performed to identify studies published up until April 2013. RESULTS: 292 publications focussing on concussion met the inclusion criteria, and so they were quality rated and reviewed. CONCLUSION: Concussion is hard to recognize and diagnose. Initial sideline assessment via the Sports Concussion Assessment Tool 3 (SCAT3), Child-SCAT3 or King-Devick test should be undertaken to identify athletes with concussion as part of a continuum of assessment modalities and athlete management. Sports medicine practitioners should be cognisant of the definition, extent and nature of concussion, and should work with coaches, athletes and trainers to identify and manage concussions. The most common reason for variations in management of concussion is lack of awareness of-and confusion about-the many available published guidelines for concussion. Future research should focus on better systems and tools for recognition, assessment and management of concussion. Sport participants' knowledge of concussion should be evaluated more rigorously, with interventions for sports where there is little knowledge of recognition, assessment and appropriate management of concussion.

Una historia de éxito: nuevas reglas y menos lesiones en la Lucha Leonesa (2005-2012) / A success story: New rules and fewer injuries in traditional Leonese Wrestling (2006-2012)

Objective: To analyse the effectiveness of a change in the rules on the incidence of injuries in traditional Leonese Wrestling (LW). Material and methods: Cohort study, retrospective (2006–2007) and prospective (2008–2012). The population studied comprised all the male wrestlers over 16 years of age who took part in Winter League competitions in the seasons 2006–2012. Data collected included the number, location and severity of injuries. Classifying them according to location and severity, the incidence of injuries by bouts and falls before and after the change was calculated. The formula for calculating effectiveness was: 1 - relative risk. Results: Over the 7 seasons, a total of 34 injuries were reported - 9 in the seasons before the change and 25 afterwards. Since the introduction of the new regulations in 2008, no serious upper limb injuries have been reported. Before the change in rules there was an incidence of 10.4 per 1000 bouts and 3.9 for every 1000 falls, the differences being statistically significant (P = 0.002 and P = 0.006, respectively). The effectiveness in reducing the incidence of serious injuries was 94% by bouts, and 91% by falls. Conclusions: The results of this study confirm the importance of a methodological approach for the prevention of injuries; in this case a change in the rules (AU)

Objective: To analyse the effectiveness of a change in the rules on the incidence of injuries in traditional Leonese Wrestling (LW). Material and methods: Cohort study, retrospective (2006–2007) and prospective (2008–2012). The population studied comprised all the male wrestlers over 16 years of age who took part in Winter League competitions in the seasons 2006–2012. Data collected included the number, location and severity of injuries. Classifying them according to location and severity, the incidence of injuries by bouts and falls before and after the change was calculated. The formula for calculating effectiveness was: 1 – relative risk. Results: Over the 7 seasons, a total of 34 injuries were reported — 9 in the seasons before the change and 25 afterwards. Since the introduction of the new regulations in 2008, no serious upper limb injuries have been reported. Before the change in rules there was an incidence of 10.4 per 1000 bouts and 3.9 for every 1000 falls, the differences being statistically significant (P = 0.002 and P = 0.006, respectively). The effectiveness in reducing the incidence of serious injuries was 94% by bouts, and 91% by falls. Conclusions: The results of this study confirm the importance of a methodological approach for the prevention of injuries; in this case a change in the rules (AU)

Introducción: El objetivo de nuestro estudio es analizar la efectividad de un cambio de reglamento en la incidencia de lesiones de Lucha Leonesa. Material y métodos: Estudio de cohorte retrospectivo (2006-2007) y prospectivo (2008-2012). La población estudiada comprendió todos los luchadores masculinos de más de 16 años que participaron en las Ligas de Invierno en las temporadas del 2006-2012. Se recogieron datos sobre el número, la localización y la severidad de las lesiones, clasificándolos según su localización y su gravedad. Se calculó la incidencia de lesiones por combates y por caídas antes y después del cambio de reglamento. La fórmula para calcular la efectividad fue: 1 - Riesgo Relativo. Resultados: En las 7 temporadas, se registraron un total de 34 lesiones, 9 antes del cambio de reglamento y 25 después. Desde la introducción de las nuevas reglas en 2008 no se produjo ninguna lesión grave en los miembros superiores, mientras que antes del cambio de reglamento la incidencia de lesiones fue de 10,4 por cada 1000 combates y de 3,9 por cada 1000 caídas, siendo estadísticamente significativa (p= 0,002 y p=0,006). La efectividad de la reducción de la incidencia de lesiones graves fue del 94% por combates y del 91% por caídas. Conclusiones: Los resultados de este estudio confirman la importancia de un enfoque metodológico para la prevención de lesiones; en este caso, los cambios de reglamento (AU)