Avenues for prevention using the epidemiology of sport-related concussion from a large high school surveillance study.

OBJECTIVE: Epidemiology provides fundamental opportunities to protect student-athlete health. The goal of this study was to describe the epidemiology of sport-related concussion (SRC) across 8 years (2015/2016-2022/2023) and compare boys' and girls' sports for SRC incidence and SRC mechanisms. METHODS: This was a retrospective cohort study performed using a statewide high school head injury surveillance system of high school student-athletes (n = 2,182,128; boys, n = 1,267,389; girls, n = 914,739). Exposures of interest included study year and boys and girls in comparable sports. Clinical incidence was calculated by dividing SRC counts in each sport by the number of participants per 100 player-seasons and presented with 95% CIs. The 2019/2020 and 2020/2021 data were included in the analysis, however caution is warranted due to the COVID-19 pandemic. Clinical incidence ratios (CIRs) were estimated for sex-comparable sports, and significance was determined if 95% CIs excluded 1.00. The authors compared mechanism of injury in boys' and girls' comparable sports with chi-square analyses (p < 0.05). RESULTS: Among 25,482 total SRCs, the overall clinical incidence of SRC for all boys and girls was 1.17 (95% CI 1.15-1.18) per 100 player-seasons across all years. Across all years, the overall clinical incidence in boys' sports was 1.34 (95% CI 1.32-1.36) per 100 player-seasons, and 0.93 (95% CI 0.91-0.95) per 100 player-seasons in girls' sports. Boys' sports with the highest clinical incidence included football, ice hockey, and wrestling. Girls' sports with the highest clinical incidence included basketball, soccer, lacrosse, competitive cheer, and gymnastics. Girls consistently had higher SRC rates relative to boys for baseball/softball, basketball, and soccer (CIR range 1.65 [95% CI 1.41-1.93] to 3.32 [95% CI 2.67-4.16]). Girls had lower SRC in lacrosse in 2015/2016 (CIR 0.63, 95% CI 0.40-0.97); no difference in 2016/2017-2020/2021, but had higher clinical incidence in 2021/2022 (CIR 1.69, 95% CI 1.18-2.44) relative to boys. In boys the most common mechanism of SRC occurred from person-to-person contact (n = 8752, 62.8%), whereas girls commonly sustained SRC from person-to-object contact (n = 2369, 33.4%) and from person-to-person contact (n = 2368, 33.4%). There were significant associations between boys' versus girls' sports and mechanism of injury within baseball/softball (χ2 = 12.71, p = 0.005); basketball (χ2 = 36.47, p < 0.001); lacrosse (χ2 = 185.15, p < 0.001); and soccer (χ2 = 122.70, p < 0.001). CONCLUSIONS: These findings can help understand the potential impact of interventions aimed at preventing or reducing SRC. Including girls' sports within this study extends research for a largely underrepresented group.

Impact of the Soweto football derby on the trauma emergency department at Chris Hani Baragwanath Academic Hospital, a tertiary level hospital in South Africa.

INTRODUCTION: The Soweto Derby is one of Africa's largest football derbies. The two rival teams, Kaizer Chiefs and Orlando Pirates, both originate in Soweto, a sprawling township 20km outside Johannesburg. Soweto is infamous for the high levels of violent crime and trauma, but also for Chris Hani Baragwanath Academic Hospital (CHBAH), with one of the world's largest trauma emergency departments (ED). Research globally, describing the impact of sports events on public health care systems is conflicting, with evidence showing both increases and decreases in spectator related trauma. This paper seeks to describe the trauma burden during the Soweto Derby and add to the research concerning trauma relating to sporting derbies in low to middle income countries. OBJECTIVES: To analyze the impact of the Soweto Derby on the trauma ED at CHBAH over a 24-hour period. METHODS: A retrospective comparative study at the CHBAH Trauma ED of 13 Soweto Derbies played over a 5 year period between 2015-2019, compared to the corresponding non-Soweto Derby days of the preceding year. Patients were triaged according to the South African Triage Scale and Advanced Trauma Life Support (ATLS) principles. Data was organized into 3 time frames where the triage score and mechanism of injuries were compared: 1) 4 hours pre-match, 2) 2 hours during the match, and 3) 18 hours post-match. RESULTS: Thirteen Soweto Derbies and 2552 patients were included. The median age was 29 with males accounting for 73.4% of all trauma cases. Significantly more P1 patients presented during the Soweto Derby. Pre-match there were 3x less P1 patients presenting to the ED (4.7% vs 12%, p = 0.044). During the match, there was a 40% drop in males presenting to ED (5.95% vs 9.45%, p = 0.015). Post-match there was a significant increase in P1 patients treated (17.4% vs 13.5%, p = 0.021)), with the majority being young males. There was no increase in either female or paediatric visits to the ED. CONCLUSION: The Soweto Derby has a direct effect on the trauma burden at CHBAH, with more P1 patients presenting post-match. Young African males are disproportionally affected by severe trauma requiring increased health care resources in an already overburdened hospital.

Unveiling the nonlinear dynamics of player performance in China's super league as a function of age.

To explore the dynamics in physical and technical performance of professional football players and changes across age groups. Match statistics were collected from 1900 games across ten seasons (2012-2021) in the Chinese Super League. Generalized additive models visualized age-related trends in 12 key performance indicators including technical and physical variables. Revealed nonlinear trajectories characterized by rapid early declines, stable peak periods and accelerated late decreases. Physical indicators decreased progressively from the early 20 s before stabilizing briefly then declining further after 30. Conversely, technical metrics gradually improved into the late 20 s and early 30 s prior to decreasing again. This study provides novel evidence that football performance changes nonlinearly across age. Targeted training and development strategies should be tailored to the specific needs of different career stages.

Nutritional perspectives in female soccer: a scoping review.

BACKGROUND: The purpose of the review was to evaluate the literature exploring nutritional habits and practices in female soccer players. METHODS: The PRISMA-ScR Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews were followed. Searches of Web of Science, PubMed and Scopus databases were conducted for studies exploring the nutritional habits and practices of female soccer players. RESULTS: A total of 72 studies were included in the scoping review. Studies on female soccer players mainly focused on daily energy expenditure, daily energy and macronutrient intake and hydration status. A negative energy balance was consistent across studies, and the ingestion of CHO appears below the current recommendations. Female soccer players are predominately in negative energy balance, which may indicate that they are at risk of low energy availability. A high use of nutritional supplements is apparent in female soccer, whilst a large proportion of players commence training dehydrated. CONCLUSIONS: The current findings have implications for practitioners relating to the planning, management, monitoring, and implementation of nutritional intake and training and competition schedules.

Accuracy of a non-exercise method using seismocardiography for the estimation of V̇O2peak in sub-elite football players.

A non-exercise method equation using seismocardiography for estimating V̇O2peak (SCG V̇O2peak) has previously been validated in healthy subjects. However, the performance of the SCG V̇O2peak within a trained population is unknown, and the ability of the model to detect changes over time is not well elucidated. Forty-seven sub-elite football players were tested at the start of pre-season (SPS) and 36 players completed a test after eight weeks at the end of the pre-season (EPS). Testing included an SCG V̇O2peak estimation at rest and a graded cardiopulmonary exercise test (CPET) on a treadmill for determination of V̇O2peak. Agreement between SCG V̇O2peak and CPET V̇O2peak showed a large underestimation at SPS (bias ± 95% CI: -9.9 ± 1.8, 95% Limits of Agreement: 2.2 to -22.0 mL·min-1 kg-1). At EPS no interaction (p = 0.3590) but a main effect of time (p < 0.0001) and methods (p < 0.0001) was observed between SCG and CPET V̇O2peak. No correlation in V̇O2peak changes was observed between SCG and CPET (r = -20.0, p = 0.2484) but a fair agreement in classifying the correct directional change in V̇O2peak with the SCG method was found (Cohen's κ coefficient = 0.28 ± 0.25). Overall, the SCG V̇O2peak method lacks accuracy and despite being able to estimate group changes, it was incapable of detecting individual changes in V̇O2peak following a pre-season period in sub-elite football players. The SCG algorithm needs to be further adjusted and the accuracy and precision improved for the method to be applicable for use within a trained population.

The effects of simulated monocular and binocular vision impairment on football penalty kick performance.

Sports performance is relatively robust under high levels of binocular blur. However, the limited research studies investigating monocular impairments has shown it has a larger impact on sport performance. This research study is relevant for classification in sports for athletes with vision impairment (VI), where visual acuity (VA) from the better eye is used during classification. Across two experiments, we aimed to establish the point at which binocular and monocular impairments affected performance in a football penalty kick (PK) through simulating varying severities of degraded VA and contrast sensitivity (CS) in active football players. In experiment one, 25 footballers performed PKs as VA and CS were systematically decreased in both eyes, and in one condition, visual field (VF) was reduced. The most severe VA/CS condition and reduced VF significantly impacted outcome, ball velocity and placement (ball kicked closer to the centre of the goal) (p < 0.05). In experiment two, 29 different footballers performed PKs as VA and CS of only the dominant eye were systematically decreased and in one condition the dominant eye was occluded, and participants viewed their environment through the non-dominant eye (monocular viewing). No differences were observed when assessing monocular impairments influence on outcome, velocity and ball placement. PKs have a high resilience to VI, but binocular impairment has a more immediate effect, suggesting binocular measures should be used in classification processes in football.

Are we tackle ready? Cross-sectional video analysis of match tackle characteristics in elite women's Rugby Union.

The tackle contest is the most common and most injurious match contact event in rugby and is an indicator of performance. Tackle Ready is World Rugby's tackle technique education program. Limited research has characterized the tackle contest in women's rugby. The purpose of this study is to: (1) identify the match situational characteristics, ball-carrier and tackler technical actions demonstrated in elite women's Rugby Union and (2) to determine the extent to which Tackle Ready recommended tackle techniques were exhibited. Technical characteristics for 1500 tackle events in the 2022-2023 Women's Six Nations Championship were visually assessed according to a predefined coding framework and the Tackle Ready program. Tackles lacked full completion (0.2%) of the 22 coded Tackle Ready techniques with 47% of the recommended techniques demonstrated in each tackle on average (range 15%-98%). A high proportion of tackles involved two defenders (48%), approaching ball-carriers from the side (38%) or oblique angles (39%), in an upright position (30%), and with initial contact made with the arm (51%). Incorrect pre-contact head positioning and head placement upon contact accounted for 50% and 15% of tackles, respectively, and there was a mean of 14 (95% CI 11-18) head and neck contacts to a tackler and 18 (95% CI 14-22) head and neck contacts to a ball-carrier per game. Targeted interventions to encourage adoption of recommended techniques are needed to reduce tackle-related injury risk in women's rugby. This study provides valuable context for future discussion across law enforcement, coach education and gender-specific tackle coaching in the women's game.

Risk and prevalence of Relative Energy Deficiency in Sport (REDs) among professional female football players.

A high prevalence of low energy availability (LEA) has been reported in female football players. This is of concern as problematic LEA may evolve into a syndromic pattern known as relative energy deficiency in sport (REDs). Given the difficulties in accurately assessing LEA, our study shifts emphasis to measurable indicators of REDs, serving as proxies for health detriments caused by LEA. The present cross-sectional study aimed to quantify the risk of REDs and to assess the prevalence of indicators indicative of the syndrome. 60 players (tiers 3 and 4) from three Norwegian football teams were analyzed as a single cohort but also stratified based on player position and menstrual status. The proportion of players at risk for REDs was 22%, that is, 17% with mild, 3% with moderate to high, and 2% with very high/extreme risk, respectively. The majority of the cohort (71%) presented with no primary indicators, while 20%, 7%, and 2% presented with one, two, and three primary indicators, respectively. Regarding secondary indicators, 57% had none, 33% had one, and 10% had two indicators. For associated indicators, 30% had none, 42% had one, 18% had two, 8% had three, and 2% had four indicators. Player position did not affect the prevalence of REDs indicators. Among noncontraceptive users (n = 27), secondary amenorrhea (AME) was reported by 30%. These findings indicate that health and performance teams should prioritize universal health promoting strategies rather than selective or indicative strategies. Particularly, focus on nutritional periodization to secure sufficient energy availability, mitigating the risk of problematic LEA and REDs should be addressed.

Economic impact of muscle injury rate and hamstring strain injuries in professional football clubs. Evidence from LaLiga.

The aims of this study were: 1) to describe the total muscular injuries, and specifically HSIs, and their corresponding missed matches; 2) to analyse their economic impact; and 3) to estimate the loss of incomes due to TV rights, in first division clubs from LaLigaTM depending on the expected and actual ranking position during the 2018/2019 season. To do that, a cross-sectional study for season 18/19 and for all players of the 20 Spanish professional football clubs was performed. The economic impact of injuries was estimated considering the missed matches and salary cost of all players and the audio-visual income loss was estimated considering the Spanish Royal Decree of Law (RDL 5/2015). The high number of muscular (270) and hamstring injuries (57) implies a high cost for professional first division football clubs, specifically € 365,811 per month for the former and € 47,388 per month for the latter. In addition, reaching a worse than expected position in LaLigaTM ranking involved a loss of 45,2 million € in TV rights incomes. The high cost of muscle injuries in first division teams justifies the need for multidisciplinary teams that are capable of reducing the number of injuries as well as recovery times.

Decision-making accuracy of soccer referees in relation to markers of internal and external load.

This study examined the relationships between the decision-making performances of soccer referees and markers of physiological load. Following baseline measurements and habituation procedures, 13 national-level male referees completed a novel Soccer Referee Simulation whilst simultaneously adjudicating on a series of video-based decision-making clips. The correctness of each decision was assessed in relation to the mean heart rate (HR), respiratory rate (RR), minute ventilation (VE), perceptions of breathlessness (RPE-B) and local muscular (RPE-M) exertion and running speeds recorded in the 10-s and 60-s preceding decisions. There was a significant association between decision-making accuracy and the mean HR (p = 0.042; VC = 0.272) and RR (p = 0.024, VC = 0.239) in the 10-s preceding decisions, with significantly more errors observed when HR ≥ 90% of HRmax (OR, 5.39) and RR ≥ 80% of RRpeak (OR, 3.34). Decision-making accuracy was also significantly associated with the mean running speeds performed in the 10-s (p = 0.003; VC = 0.320) and 60-s (p = 0.016; VC = 0.253) preceding decisions, with workloads of ≥250 m·min-1 associated with an increased occurrence of decisional errors (OR, 3.84). Finally, there was a significant association between decision-making accuracy and RPE-B (p = 0.021; VC = 0.287), with a disproportionate number of errors occurring when RPE-B was rated as "very strong" to "maximal" (OR, 7.19). Collectively, the current data offer novel insights into the detrimental effects that high workloads may have upon the decision-making performances of soccer referees. Such information may be useful in designing combined physical and decision-making training programmes that prepare soccer referees for the periods of match play that prove most problematic to their decision-making.

Predicting sports performance of elite female football players through smart wearable measurement platform.

Recent development of information technology and wearable devices has led to the analysis of multidimensional sports information and the enhancement of athletes' sports performance convenient and potentially more efficient. In this study, we present a novel data platform tailored for capturing athletes' cognitive, physiological, and body composition data. This platform incorporates diverse visualization modes, enabling athletes and coaches to access data seamlessly. Fourteen elite female football players (average age=20.6±1.3years; 3 forwards, 5 midfielders, 4 defenders, and 2 goalkeepers) were recruited from National Taiwan Normal University, Taiwan, as the primary observational group, and 12 female university students without regular sport/exercise habits (average age=21.6±1.3years) were recruited as control group. Through multidimensional data analysis, we identified significant differences in limb muscle mass and several cognitive function scores (e.g., reaction times of attention and working memory) between elite female football varsity team and general female university students. Furthermore, 1-month heart rate data obtained from wearable devices revealed a significant negative correlation between average heart rate median and cognitive function scores. Overall, this study demonstrates the potential of this platform as an efficient multidimensional data collection and analysis platform. Therefore, valuable insights between cognitive functions, physiological signals and body composition can be obtained via this multidimensional platform for facilitating sports performance.

Thermography method under the influence of exercise in the detection of muscle injuries: Sartorius muscle case report.

BACKGROUND: The aim of this study was to determine the level of participation in the training of the athlete who applied to the clinic with pain by infrared thermography. Symptoms of sartorius muscle (SM) injury are like rectus femoris injuries. CASE SCENARIO: Grade I SM injury of a 23-year-old male football player was determined by thermographic diagnosis. Taking a resting thermal image before the training of the player reported a pain in the upper thigh region. OUTCOMES: Since both legs were equally loaded, in accordance with the method we developed, the thermal image was taken again after a 10-min cycling program with 30-40% resistance. The heat maps of legs seen in the pre- and post-training images were analyzed. There was no asymmetrical finding indicating injury in the resting thermographic evaluation, but asymmetric findings showing the injury in the region of SM were obtained in the repeated thermographic imaging after the 10-min cycling program. Grade I SM injury was detected by MRI afterwards. CONCLUSION: Even if there is no sign of asymmetry in the resting thermography of football players having signs of pain, the injured muscle should be provoked with a safe exercise program and the thermal image should be retaken.

Acute effects of Nordic hamstring exercise on hip and knee joints proprioception.

BACKGROUND AND OBJECTIVES: Nordic Hamstring Exercise (NHE) is one of the best exercises proposed for injury prevention of hamstring muscles. However, its effects on lower extremity proprioception are unclear. The aim of this study was to investigate the immediate effects of a single bout of NHE on hip and knee joints' proprioception. METHODS: Forty collegiate male soccer players participated in this study with a mean age of 22.85 ± 1.82 years and were randomized into either control (n = 20) or experimental (n = 20) groups. Each subject participated in pre-test measurements in which hip and knee active joints position sense (JPS) were assessed in standing and lying tasks using the image-capturing method. The experimental group then performed three sets of NHE with 10 repetitions in each set, while the control group rested for 10 min. Paired and independent t-tests were used for calculating the differences within and between groups on SPSS software, respectively. The level of significance was P ≤ 0.05. RESULTS: Hip JPS in the lying task and knee JPS in both of the standing and lying tasks were impaired significantly after performing a single bout of NHE (P ≤ 0.05). However, the effects of this exercise on hip JPS in the standing task were not significant (P ≥ 0.05). CONCLUSIONS: NHE performing with three sets of 10 repetitions can significantly impair hip and knee JPS immediately after exercise and reduce the proprioception acuity of the lower limbs. It is recommended to perform this exercise at a time rather than before training or match sessions.

Things to keep in mind when selecting physical assessments in youth soccer: Correlations between test performances, interlimb asymmetries, and effects of maturation.

A range of field-based tests have been proposed for inclusion in physical performance assessment batteries. However, there are obvious time and human resources constraints in applied settings. The knowledge of potential relationships between tests on performance, asymmetries, as well as maturation-induced changes, may help select the most informative and least time-consuming testing battery. The purposes of this study were: (1) to determine correlations in performance between different field-based tests, in interlimb asymmetry between those unilateral tests, and between asymmetry scores and test performances, and (2) to determine the influence of players' maturity status on test performances and asymmetries. A total of 309 male youth soccer players completed a nine-test battery including y-balance test, drop vertical jump, countermovement jump, single leg countermovement jump, standing long jump, single leg hop for distance, Illinois agility test, 10 m sprint, and 20 m sprint. The results revealed moderate-to-very large relationships between jump, sprint, and agility performances (r = 0.43-0.94), but weak-to-moderate correlations between these tests and balance scores (r ≤ 0.38). No relevant relationship (r ≤ 0.32) for asymmetries detected through different unilateral tests was found, nor between asymmetries and performance scores (r < 0.29). While maturity status clearly influenced players' performance, a limited impact on asymmetries was evident. Despite the mentioned relationships, the low shared variance between tests indicates that they should not be used interchangeably, and coaches should select those with the greatest specificity for the sport. Asymmetries do not influence performance, but their prevalence and unchanging nature with maturation can be seen as an opportunity for the identification of highly asymmetrical players and the application of interventions to improve the weaker limb, irrespective of the athlete's stage of development. To this end, the single leg countermovement jump might be viewed as an appropriate test in male youth soccer.

The effect of core stability training on ball-kicking velocity, sprint speed, and agility in adolescent male football players.

This study was conducted to investigate the effect of core stability training program on ball-kicking velocity, running speed, and agility in adolescent male football players. To this end, 36 male football players aged 12-14 were divided into the training group and control group. Before implementing the core stability training program, participants' ball-kicking velocity, sprint speed, and agility performance were measured with a Bushnell velocity radar gun, 20 m sprint test, and 505 agility test, respectively, in both training group and control group. After the measurements, the training group followed core stability training program three days a week, for eight weeks in addition to the routine training program, while the control group followed the routine training program only. Ball-kicking velocity, sprint speed, and agility performance were re-measured in both groups after the completion of the core stability training program. Significant improvements were detected in all parameters, i.e., ball-kicking velocity, sprint speed, and agility performance in the training group (p<0.05). On the other hand, in the control group, no significant change was detected in the ball-kicking velocity and sprint speed (p>0.05), whereas a significant improvement was observed in agility performance (p<0.05). Inter-group comparisons revealed statistically significant differences between the groups in ball-kicking velocity and sprint speed in favor of the training group (p<0.05), while no significant difference was found between the groups in agility performance (p>0.05). In conclusion, this study's findings suggest that core stability exercises can be incorporated into the routine training program of adolescent male football players.

Embracing the impact from instrumented mouthguards (iMGs): A survey of iMG managers' perceptions of staff and player interest into the technology, data and barriers to use.

Instrumented mouthguards (iMGs) are a novel technology being used within rugby to quantify head acceleration events. Understanding practitioners' perceptions of the barriers and facilitators to their use is important to support implementation and adoption. This study assessed men's and women's rugby union and league iMG managers' perceptions of staff and player interest in the technology, data and barriers to use. Forty-six iMG managers (men's rugby union and league n = 20 and n = 9 and women's rugby union and league n = 7 and n = 10) completed an 18-question survey. Perceived interest in data varied across staff roles with medical staff being reported as having the most interest. The iMG devices were perceived as easy to use but uncomfortable. Several uses of data were identified, including medical applications, player monitoring and player welfare. The comfort, size and fit of the iMG were reported as the major barriers to player use. Time constraints and a lack of understanding of data were barriers to engagement with the data. Continued education on how iMG data can be used is required to increase player and staff buy-in, alongside improving comfort of the devices. Studies undertaken with iMGs investigating player performance and welfare outcomes will make data more useful and increase engagement.

Validation of Step Detection and Distance Calculation Algorithms for Soccer Performance Monitoring.

This study focused on developing and evaluating a gyroscope-based step counter algorithm using inertial measurement unit (IMU) readings for precise athletic performance monitoring in soccer. The research aimed to provide reliable step detection and distance estimation tailored to soccer-specific movements, including various running speeds and directional changes. Real-time algorithms utilizing shank angular data from gyroscopes were created. Experiments were conducted on a specially designed soccer-specific testing circuit performed by 15 athletes, simulating a range of locomotion activities such as walking, jogging, and high-intensity actions. The algorithm outcome was compared with manually tagged data from a high-quality video camera-based system for validation, by assessing the agreement between the paired values using limits of agreement, concordance correlation coefficient, and further metrics. Results returned a step detection accuracy of 95.8% and a distance estimation Root Mean Square Error (RMSE) of 17.6 m over about 202 m of track. A sub-sample (N = 6) also wore two pairs of devices concurrently to evaluate inter-unit reliability. The performance analysis suggested that the algorithm was effective and reliable in tracking diverse soccer-specific movements. The proposed algorithm offered a robust and efficient solution for tracking step count and distance covered in soccer, particularly beneficial in indoor environments where global navigation satellite systems are not feasible. This advancement in sports technology widens the spectrum of tools for coaches and athletes in monitoring soccer performance.

Application of Machine Learning Methods to Investigate Joint Load in Agility on the Football Field: Creating the Model, Part I.

Laboratory studies have limitations in screening for anterior cruciate ligament (ACL) injury risk due to their lack of ecological validity. Machine learning (ML) methods coupled with wearable sensors are state-of-art approaches for joint load estimation outside the laboratory in athletic tasks. The aim of this study was to investigate ML approaches in predicting knee joint loading during sport-specific agility tasks. We explored the possibility of predicting high and low knee abduction moments (KAMs) from kinematic data collected in a laboratory setting through wearable sensors and of predicting the actual KAM from kinematics. Xsens MVN Analyze and Vicon motion analysis, together with Bertec force plates, were used. Talented female football (soccer) players (n = 32, age 14.8 ± 1.0 y, height 167.9 ± 5.1 cm, mass 57.5 ± 8.0 kg) performed unanticipated sidestep cutting movements (number of trials analyzed = 1105). According to the findings of this technical note, classification models that aim to identify the players exhibiting high or low KAM are preferable to the ones that aim to predict the actual peak KAM magnitude. The possibility of classifying high versus low KAMs during agility with good approximation (AUC 0.81-0.85) represents a step towards testing in an ecologically valid environment.

The Role of Virtual Reality in the Management of Football Injuries.

Injuries represent a serious concern for football players, with a significant loss in terms of sport participation and long periods of rehabilitation. According to the 2019/20 UEFA Élite Club Injury Report, the average incidence of injuries during training is 2.8 per 1000 h of training, with an average absence from training of 20 days. In addition, injured athletes are 4 to 7 times more likely to relapse than uninjured athletes. High workloads and reduced recovery periods represent two of the most important modifiable risk factors. In this context, prevention and an adequate rehabilitation protocol are vital in managing injuries, reducing their incidence, and improving the return to competition. In recent years, technological development has provided new tools in rehabilitation, and Virtual reality (VR) has shown interesting results in treating neurologic and orthopedic pathologies. Virtual Reality (VR) technology finds application in the sports industry as a tool to examine athletes' technical movements. The primary objective is to detect the biomechanical risk factors associated with anterior cruciate ligament injury. Additionally, VR can be used to train athletes in field-specific techniques and create safe and controlled therapeutic environments for post-injury recovery. Moreover, VR offers a customizable approach to treatment based on individual player data. It can be employed for both prevention and rehabilitation, tailoring the rehabilitation and training protocols according to the athletes' specific needs.

Long-term Outcomes of Multiligament Knee Injuries in American Football Players.

BACKGROUND: Long-term outcomes for isolated anterior cruciate ligament (ACL) reconstructions in competitive American football athletes are well reported in the literature, but little data currently exist regarding multiligament knee injury (MLKI) reconstruction outcomes. PURPOSE: To examine patient-reported and return-to-sport outcomes of competitive American football athletes who underwent primary, single-staged, multiligament knee reconstruction. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We identified patients from our institution's prospectively collected data repository between 2001 and 2020 who underwent single-staged surgical reconstruction of an MLKI sustained during competitive participation in American football. We assessed patient-reported outcomes at a minimum of 2 years after surgery using the International Knee Documentation Committee (IKDC) Subjective Knee Form and questions regarding surgical satisfaction and return to sport. Successful return to sport was defined as a return to preinjury level of competition. We summarized all outcome data and compared outcomes between 2-ligament and >2-ligament groups and between ACL-only MLKI injury and bicruciate MLKI injury groups using independent t test for IKDC scores and chi-square test for return to sport. Additionally, we evaluated predictors of postoperative IKDC scores using linear regression and predictors of return to sport using logistic regression. RESULTS: Outcome data were successfully collected for 53 of 73 total eligible patients (73%; mean follow-up time, 7.7 ± 4.0 years; all male; mean age at surgery, 18.1 ± 2.7 years). The mean postoperative IKDC score was 84 ± 16. The most common level of preinjury competition was high school (n = 36; 68%), followed by college (n = 10; 19%). Seven patients did not return to sport competition at any level due to limitations from their knee surgery, and 82% of patients that attempted to return to preinjury level of sport were able to do so. A total of 50 patients (94%) were satisfied or very satisfied with their surgical outcome. The 2-ligament (n = 39) and >2-ligament (n = 14) groups did not significantly differ in IKDC scores (P = .96) or proportions with successful return to sport (P = .77). Similarly, the ACL-MLKI injury (n = 39) and bicruciate MLKI injury (n = 14) groups did not significantly differ in IKDC scores (P = .89) or proportions with successful return to sport (P = .77). Age and body mass index were not significantly associated with IKDC scores or successful return to sport at follow-up (all P > .05). CONCLUSION: This study may represent the largest cohort of competitive American football athletes evaluated for longitudinal outcomes after multiligament knee reconstruction. Despite the severity of these injuries, we found good knee-related function and that the large majority of athletes who attempted to return to sport were successful. The majority of athletes (94%) were satisfied with their operative treatment.