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- Title
Poster 370: From Head to Toe: Investigating Post-Concussion Risks for Lower Extremity Injuries in Young Athletes.
- Authors
Woodrow, Jackson; Galal, Youssef; Koolmees, Wyatt; Vohra, Arjun; Lederman, Evan; Shah, Anup
- Abstract
Objectives: Between 1.7 and 3 million sports-related concussions occur every year and pose a significant concern for sports medicine physicians, given their profound impact on athletes' health. Standard post-concussion protocols for athletes typically prescribe a 24-hour cessation of all athletic activities, followed by cautious resumption of light aerobic exercises and gradually increasing to competition no earlier than one week, provided the athlete is symptom-free. While an estimated 90% of concussion-induced symptoms are transient and resolve within two weeks, the absence of a biomarker-based test makes tracking recovery progression challenging. Existing return-to-play guidelines primarily focus on cognitive and executive functions, often overlooking the assessment of proprioceptive abilities. This omission may place athletes at an increased risk of subsequent lower extremity injuries during competition. This study seeks to assess the rate of lower extremity injuries in athletes in the year following their first concussion, aiming to determine if current guidelines warrant revision to better safeguard against future injuries. Methods: This retrospective cohort study utilized a patient record database compiled by PearlDiver Database (PearlDiver, Colorado Springs, CO, USA) which provides access to de-identified information from 151 million patients spanning 2007 to 2020. The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes for sports physicals and activity in sports were used to create a population of athletes. Then, ICD-10 codes for concussions were used to create a second population of patients who experienced a concussion. All patients had to be active in the PearlDiver system for at least one year prior to and following their specified diagnosis to be eligible for this study. From the athlete population, we identified a group of patients who suffered a concussion within one year of having a sports physical ICD-10 code or other sports-related diagnosis. A control population was created to include athletes who did not suffer from a concussion for a minimum of one year before and after the study commenced. Finally, both populations were filtered by age to focus on patients below the age of 30. ICD-10 codes for acute lower extremity injuries, such as joint sprains, joint dislocations, muscle strains, ankle fractures, and meniscal tears were used to identify specific injuries within the concussed and non-concussed populations. Tendonopathies, fractures related to trauma, and ambiguous diagnostic codes were excluded. A full list of ICD-10 codes used to establish the populations is found in Table 1 of the Appendix. Results: There were a total of 1,326,554 athletes that met the inclusion criteria with a median age of 15. Of the athletes, 88,917 (6.7%) suffered a concussion during the timeframe of the study. A total of 10,104 (11.4%) concussed athletes endured some sort of acute lower extremity injury within 1 year of their first concussion. The most common injuries were ankle sprain (n = 4894), knee sprain (n = 2514), unspecified ankle injury (n = 1995), meniscal injury (n = 1257), and unspecified foot injury (n = 1227). When compared to the non-concussed athlete population, there was a significant increase in the risk of suffering an unspecified ankle injury (odds ratio = 1.31; 95% CI = 1.26 - 1.36), unspecified foot injury (1.16; 1.10 - 1.22), foot sprain (1.14; 1.07 - 1.21), lower extremity muscle strain (1.12; 1.05 - 1.19), and ankle sprain (1.10; 1.07 - 1.13). As shown in Table 2, the incidence of all lower extremity injuries was lower in the first 3 months following a concussion but then increased in the 6 - 9 month period. Conclusions: Our study found a significant increase in the likelihood of suffering several types of lower extremity injuries following a concussion. Specifically, athletes who had experienced a concussion displayed an increased risk of suffering an unspecified ankle injury, unspecified foot injury, foot sprain, lower extremity muscle strain, or ankle sprain within 1 year compared to their non-concussed athlete counterparts. The cause for this increase is likely multifactorial, but could include delayed improvements in proprioceptive abilities compared to cognitive and executive functioning which largely dictate the return-to-play timeframe. This study has multiple limitations. The first and most important being that it is a large-scale database study. While this allows for an increased sample size, the insights from the data are limited by ICD code classifications. Additionally, with a database study, the data is de-identified and patient chart information is not available, making it difficult to control for potential confounding variables, such as training schedule, playing surfaces, medical care, and return-to-play protocol. Furthermore, depending on the timing of the injury, players may opt to extend their recovery, sit out for the remainder of the season, or stop playing the sport, which would underestimate the perceived correlation between a concussion and subsequent lower extremity injury. With the increased risk of injury in the year following a concussion, sports medicine physicians and athletic training staff should more closely monitor post-concussion athletes for lower extremity injuries. Preventative strategies, such as bracing or physical therapy regimens focused on joint stability, could be incorporated to protect athletes from sustaining another injury, and additional studies into refining post-concussion rehabilitation would be helpful in shedding light on the best course of action to protect athlete health.
- Subjects
COLORADO; LEG injuries; SPORTS injuries risk factors; SPORTS injury prevention; MEDICAL protocols; RISK assessment; CONFERENCES & conventions; BRAIN concussion; DISEASE complications; ADOLESCENCE
- Publication
Orthopaedic Journal of Sports Medicine, 2024, Vol 12, p1
- ISSN
2325-9671
- Publication type
Academic Journal
- DOI
10.1177/2325967124S00335