Tummala, Sailesh V.

Study Design. Descriptive epidemiology study. Objective. The purpose of this study was to describe the epidemiology of neck and cervical spine injuries in collegiate athletes over a 5-year period. Summary of Background Data. The incidence and etiology of neck and cervical spine injuries in National Collegiate Athletic Association (NCAA) athletes has not been well defined in recent years. Methods. The incidence and characteristics of neck and cervical spine injuries were identified utilizing the NCAA Injury Surveillance Program database. Rates of injury were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). AEs were defined as any student participation in one NCAA-sanctioned practice or competition. Results. Nationally, there were an estimated 11,510 neck and cervical spine injuries over the 5-year period. These occurred at a rate of 7.05 per 100,000 athlete-exposures (AEs). The rate of neck and cervical spine injuries in men was 2.66 per 100,000 AEs, while women suffered injuries at a rate of 1.95 per 100,000 AEs. In sex-comparable sports, men were 1.36 times more likely to suffer a neck or cervical spine injury compared with women. Men's football (29.09 per 100,000 AEs) and women's field hockey (11.51 per 100,000 AEs) were the sports with the highest rates of injuries. These injuries were 3.94 times more likely to occur during competition compared with practice. In-season injury rates were the highest, at 8.18 per 100,000 AEs. Conclusion. The vast majority of neck and cervical spine injuries in NCAA athletes are minor and uncommon. Across all sports in both sexes, the majority of injuries were new, and occurred during in-season competitions. Most athletes returned to play within 24 hours of injury. These data can inform players, parents, coaches, athletic trainers, and physicians regarding the prevalence and rates of these injuries and potentially inform decision-making regarding injury prevention, treatment, and rehabilitation. Level of Evidence: 4

Background: Little research has focused on the rates and patterns of elbow injuries in National Collegiate Athletic Association (NCAA) student-athletes. Purpose: To describe the epidemiological patterns of elbow injuries in NCAA athletes during 5 seasons over the academic years 2009 through 2014 using the NCAA Injury Surveillance Program (NCAA-ISP) database. Study Design: Descriptive epidemiology study. Methods: A voluntary convenience sample of NCAA varsity teams from 11 sports was examined to determine the rates and patterns of elbow injuries. Rates and distributions of elbow injuries were identified within the context of sport, event type, time in season, mechanism, time lost from sport, surgical treatment, and injury type. Rates of injury were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). An AE was defined as any student participation in 1 NCAA-sanctioned practice or competition with an inherent risk of exposure to potential injury. Injury rate ratios (IRRs) and injury proportion ratios (IPRs) were then calculated to compare the rates within and between sports by event type, season, sex, mechanism, surgical treatment, and time lost from sport. Comparisons between sexes were made using only sports data that had both male and female samples. Results: Overall, 373 elbow injuries were reported in the NCAA-ISP data set during the 2009-2010 through 2013-2014 academic years among 11 varsity sports. The overall rate of injury was 1.76 per 10,000 AEs. The rate of elbow injuries in men was 0.74 per 10,000 AEs, while women experienced injuries at a rate of 0.63 per 10,000 AEs. In sex-comparable sports, men were 1.17 times more likely to experience an elbow injury compared with women. Men’s wrestling (6.00/10,000 AEs) and women’s tennis (1.86/10,000 AEs) were the sports with the highest rates of elbow injuries by sex, respectively. The top 3 highest injury rates overall occurred in men’s wrestling, baseball, and tennis. Elbow injuries were 3.5 times more likely to occur during competition compared with practice. Athletes were 0.76 times less likely to sustain an elbow injury during the preseason compared with in-season. Contact events were the most common mechanism of injury (67%). For sex-comparable sports, men were 2.41 times more likely than women to have contact as their injury mechanism (95% CI, 0.78-7.38). The majority of athletes missed less than 24 hours of participation time (67%), and only a minority (3%) of patients with elbow injuries went on to have surgical intervention. Elbow ulnar collateral ligament injuries were most common (26% of total injuries). Conclusion: Analysis of the study data demonstrated a significant rate of elbow injuries, 1.76 injuries per 10,000 AEs in NCAA collegiate athletes. Higher injury rates can be expected in males within sex-comparable sports. Elbow injuries are most common in the setting of competitions and most commonly occur secondary to contact-type mechanisms. Injuries were more likely to occur during in-season play. The majority of injuries required less than 24 hours of time away from sport and did not require surgical intervention.

Context Data from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) have indicated that ankle injuries are the most common injuries among NCAA soccer players. Objective To review 10 years of NCAA-ISP data for soccer players' ankle injuries to understand how the time period (2004–2005 through 2008–2009 versus 2009–2010 through 2013–2014), anatomical structure injured, and sex of the athlete affected the injury rate, mechanism, and prognosis. Design Descriptive epidemiology study. Setting Online injury surveillance. Main Outcome Measure(s) The NCAA-ISP was queried for men's and women's soccer ankle data from 2004 to 2014. Ankle-injury rates were calculated on the basis of injuries per 1000 athlete-exposures. Rate ratios (RRs) were used to compare injury rates. Injury proportion ratios (IPRs) were used to compare injury characteristics. Results When compared with the 2004–2005 through 2008–2009 seasons, the 2009–2010 through 2013–2014 seasons showed a similar rate of injuries (RR = 0.94, 95% confidence interval [CI] = 0.85, 1.04) but fewer days missed (P < .001) and fewer recurrent injuries (IPR = 0.55, 95% CI = 0.41, 0.74). The 4 most common ankle injuries, which accounted for 95% of ankle injuries, were lateral ligament complex tears (65.67%), tibiofibular ligament (high ankle) sprains (10.3%), contusions (10.1%), and medial (deltoid) ligament tears (9.77%). Of these injuries, high ankle sprains were most likely to cause athletes to miss ≥30 days (IPR = 1.9, 95% CI = 1.24, 2.90). Men and women had similar injury rates (RR = 1.02, 95% CI = 0.94, 1.11). Men had more contact injuries (IPR = 1.28, 95% CI = 1.16, 1.41) and contusion injuries (IPR = 1.34, CI = 1.03, 1.73) but fewer noncontact injuries (IPR = 0.86, 95% CI = 0.78, 0.95) and lateral ligamentous complex injuries (IPR = 0.92, 95% CI = 0.86, 0.98). Conclusions Although the rate of ankle injuries did not change between the 2004–2005 through 2008–2009 seasons and the 2009–2010 through 2013–2014 seasons, the prognoses improved. Among the 4 most common ankle injuries, high ankle sprains resulted in the worst prognosis. Overall, male and female NCAA soccer players injured their ankles at similar rates; however, men were more likely to sustain contact injuries.

Background: Low back injuries are common in collegiate football players and can frequently lead to persistent pain, reinjuries, and time lost from participation. Purpose: To describe the epidemiology of back injuries in National Collegiate Athletic Association (NCAA) football players during the 2009/2010 through 2013/2014 academic years utilizing the NCAA Injury Surveillance Program (ISP) database. Study Design: Descriptive epidemiology study. Methods: A convenience sample of NCAA varsity football teams was utilized to determine the rates and patterns of back injuries as well as to generate national injury estimates. The rates and distribution of back injuries were identified within the context of mechanism of injury, injury chronicity, and time lost from sport. Injury rates were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). Incidence rate ratios were calculated to compare the rates of injury between season, event type, mechanism of injury, injury chronicity, and time lost from sport. Results: Nationally, there were 267 low back injuries reported in the database. These were used to estimate 7076 back injuries over the 5-year period, approximately 82% of which were new injuries. The injuries occurred at a rate of 2.70 per 10,000 AEs. Overall, injuries were 3.12 times more likely to occur in competitions than in practices. Athletes were 4.67 times more likely to sustain a back injury during the preseason compared with the postseason but were 1.41 times more likely to sustain a low back injury during the preseason compared with the regular season. Both contact and noncontact were reported equally as the mechanism of injury (37.8% and 38.3%, respectively), and unspecified low back pain was the most common injury (64.2%). Only 1.6% of patients required surgery for their injury, and the majority of athletes (59.6%) returned to play within 24 hours. Conclusion: There was a relatively high rate of lumbar back injuries at the collegiate level (2.70/10,000 AEs), the majority of which were new injuries. About 18% of reported injuries were reinjuries. Although very few required surgery, a careful examination and work-up should be conducted to evaluate each injury. Regimented physical therapy and reconditioning programs are recommended to avert reinjuries.

Context The complex, high-energy nature of football puts players at risk for hip injuries. Objective To analyze National Collegiate Athletic Association (NCAA) Injury Surveillance Program data for men's football hip injuries from 2004–2005 through 2013–2014. Design Descriptive epidemiologic study. Setting National Collegiate Athletic Association football teams. Patients or Other Participants Data on collegiate football players was provided by the NCAA Injury Surveillance System from 2004–2005 through 2013–2014. Main Outcome Measure(s) The incidence, risk factors, rates, and distribution of hip injuries over the 10-year period from 2004–2005 through 2013–2014 were determined. Rates and distribution of injuries were analyzed by injury type, time loss, event type, time of season, recurrence, mechanism of injury, player position, and if surgery was required. Injury rate ratios were calculated to compare rates between event types and by time of season. Results A total of 1618 hip injuries occurred during 3 121 380 athlete-exposures (AEs), resulting in an overall hip injury rate of 5.18 per 10 000 AEs. Adductor strains (38.63%) were the most common type, followed by hip-flexor strains (28.55%) and hip contusions (18.23%). Players were 3.56 (95% confidence interval [CI] = 3.19, 3.98) times more likely to sustain a hip injury during competitions compared with practices. They were 2.37 (95% CI = 2.15, 2.62) and 3.56 (95% CI = 2.49, 5.08) times more likely to sustain a hip injury during the preseason than in-season or the postseason, respectively. Conclusions During the 10-year period, NCAA football players sustained higher rates of hip injuries during competitions and the preseason. The majority were noncontact injuries, resulted in time loss of less than 6 days, and did not require surgery. The injuries varied with player position and occurred most often to defensive backs. Muscle strains were the most frequent group of hip injuries, while adductor strains, hip-flexor strains, and hip contusions were the most common injury types.

Study Design. Descriptive epidemiology study. Objective. The purpose of this study was to describe the epidemiology of cervical spine injuries in collegiate football players. Summary of Background Data. The incidence and etiology of cervical spine injuries in National Collegiate Athletic Association (NCAA) football players has not been well defined in recent years. Methods. The incidence and characteristics of cervical spine injuries were identified utilizing the NCAA-ISP database. Rates of injury were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). AEs were defined as any student participation in one NCAA-sanctioned practice or competition. Results. An estimated 7496 cervical spine injuries were identified. Of these, 85.6% were categorized as new injuries. These occurred at a rate of 2.91 per 10000 AEs. Stingers were most common (1.87 per 10000 AEs) followed by cervical strains (0.80 per 10000 AEs). Injuries were nine times more likely to occur during competition when compared with practice settings. When compared with the regular season, the relative risks of sustaining a cervical spine injury during the preseason and postseason were 0.69 (95% CI 0.52–0.90) and 0.39 (95% CI 0.16–0.94), respectively. The rate of cervical spine injuries was highest in Division I athletes. Direct contact-related injuries were most common, representing 90.8% of all injuries sustained. Injuries were most common in linebackers (20.3%) followed secondarily by defensive linemen (18.2%). Most players returned to play within 24 hours of the initial injury (64.4%), while only 2.8% remained out of play for > 21 days. Conclusion. Fortunately, the rate of significant and disabling cervical spine injuries appears to be low in the NCAA football athlete. The promotion of safer tackling techniques, appropriate modification of protective gear, and preventive rehabilitation in these aforementioned settings is of continued value. Level of Evidence: 4

Background: Lumbar spine injuries in National Collegiate Athletic Association (NCAA) athletes have not been well studied. Purpose: To describe the epidemiology of lumbar spine injuries in NCAA athletes during the 2009/2010 through 2013/2014 academic years utilizing the NCAA Injury Surveillance Program (ISP). Study Design: Descriptive epidemiology study. Methods: A voluntary convenience sample of NCAA varsity teams from 25 sports was examined. Mechanism of injury, injury recurrence, and time lost from sport were recorded. Injury rates were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). AEs were defined as any student participation in 1 NCAA-sanctioned practice or competition. Injury rate ratios and injury proportion ratios were calculated to compare the rates within and between sports by event type, season, patient sex, mechanism, injury recurrence, and time lost from sport. Comparisons between sexes were made utilizing data that had both male and female samples. Results: An estimated 50,834 lumbar spine injuries were identified. The overall rate of injuries was 2.88 per 10,000 AEs. The rate of injuries was 2.60 per 10,000 AEs in men compared with 2.89 per 10,000 AEs in women for sex-comparable sports. Women were 1.11 times more likely than men to suffer a lumbar spine injury. Women's gymnastics (8.02 injuries per 10,000 AEs) and women's tennis (5.73 injuries per 10,000 AEs) had the highest rates of lumbar spine injuries. Athletes were 1.6 and 2.4 times more likely to sustain a lumbar spine injury during the preseason than the regular season or postseason, respectively. Noncontact was the most common mechanism of injury (45%). Injury recurrence was most common in men’s outdoor track (43%). Most injuries resulted in less than 24 hours of time loss from event participation (64%). Conclusion: The rate of lumbar spine injuries was high in NCAA athletes, and injuries commonly recurred (20.73%). In general, women were more likely to sustain a lumbar spine injury compared with men. Higher injury rates occurred during competition and via a noncontact mechanism of injury. In addition to prevention programs, reconditioning programs should be considered to prevent these injuries.

Background: Ankle injury is the most common injury in men’s and women’s basketball, regardless of the level of competition. Purpose: To use the National Collegiate Athletic Association (NCAA) Injury Surveillance Program/System (ISP/ISS) to review the 10-year epidemiology of ankle injuries in men’s and women’s collegiate basketball players. Study Design: Descriptive epidemiology study. Methods: The NCAA ISP was queried for men’s and women’s collegiate basketball ankle injury data from the 2004 through 2014 academic years. Ankle injury rates were calculated based on injuries per athlete-exposure (AE). Injury proportion ratios (IPRs) were determined by comparing variables between sexes. Activity and position of injury were also studied. Results: Over the 10-year study period, most ankle injuries in collegiate basketball occurred in the preseason (female, 1.45/1000 AEs; male, 2.00/1000 AEs), were contact related (female, 50.4%; male, 57.6%), were treated conservatively (female, 98.5%; male, 99.3%), and were new injuries (female, 78.0%; male, 78.9%), resulting in a time loss of less than 7 days (female, 62.7%; male, 65.2%). The most common injury types were lateral ligament complex tears (female, 83.5%; male, 80.0%), deltoid ligament tears (female, 5.6%; male, 7.2%), and high ankle sprains (female, 7.1%; male, 7.0%). Guards experienced the highest rate of ankle injuries in competition (female, 50.1%; male, 43.3%), and rebounding was found to be the most common activity during an injury (female, 30.3%; male, 34.4%). The rate of ankle injuries was significantly lower in women than in men (IPR, 0.81 [95% CI, 0.75-0.88]). Conclusion: This study found that most ankle injuries in collegiate basketball occurred during the preseason, were contact related, were treated conservatively, and were new injuries that resulted in a time loss of less than 7 days.

Background: Up to 50% of National Collegiate Athletic Association (NCAA) football players have a history of shoulder injuries. The quarterback position has been shown to have a high prevalence of these injuries because of its unique exposures. There is little information regarding the shoulder injury type and mechanism in NCAA quarterbacks. Purpose: To understand the 10-year epidemiology of specific shoulder injury rates in NCAA quarterbacks. Study Design: Descriptive epidemiology study. Methods: Shoulder injury data for collegiate football quarterbacks from the 2004 through 2014 academic years were analyzed using the NCAA Injury Surveillance Program (ISP) data set. Results: Over the 10-year study period, a total of 133 shoulder injuries to collegiate quarterbacks were reported, with 157,288 quarterback exposures. There was approximately 1 shoulder injury per 1221 exposures. The most common injuries noted were acromioclavicular sprains (45.1%, n = 60), followed by shoulder contusions (9.0%, n = 12), clavicular fractures (7.5%, n = 10), and anterior instability (5.3%, n = 7). The majority of injuries were caused by contact with a player (60.2%, n = 80) or contact with a playing surface (28.6%, n = 38), and 88% (n = 117) were deemed nonsurgical in nature. Conclusion: NCAA ISP data analysis suggests that collegiate quarterbacks sustain acute contact injuries 89% of the time and that they typically occur while being tackled, resulting in a time loss of less than 2 weeks. These injuries are commonly treated nonsurgically.

Abstract The medial patellofemoral ligament (MPFL), which is critical for both patellar stability and normal kinematics of the patellofemoral joint, is disrupted in most patellar dislocations. Consequently, MPFL reconstruction is advocated in recurrent dislocations to restore native patellar constraints. Fixation of the MPFL graft to the medial border of the patella can be achieved through various methods, each with its own benefits and drawbacks. We present a technique for MPFL fixation to the patella using all‐soft suture anchors, theoretically decreasing the risk of patellar fracture and articular surface violation. Technique Video video See video under supplementary data.