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BackgroundThe tackle is the leading cause of injury in Rugby Union. Although proficient technique, for both the tackler and ball-carrier, has been shown to lower the risk of injury in the tackle, little is known about the interaction between a tackler’s and ball-carrier’s technique in the same tackle event. ObjectiveThis study aims to describe the relationship between tackler and ball-carrier technique in injury and non-injury-related tackle events in Rugby Union. DesignAn observational, retrospective, case-control study design was used. SettingThe 2014–2018 seasons of the Currie Cup Premier Division, an elite, professional men’s Rugby Union competition. ParticipantsTwenty-nine tackle injury events (n=16 tackler; n=13 ball-carrier) were identified from injury surveillance data, and linked with match footage. For each event, two control groups were identified: non-injury tackle events by the injured player (n=89 own controls) and matched non-injury tackle events by a teammate (n=144 team controls). Assessment of risk factorsVideo footage of each tackle event was analysed, and both the ball carrier’s and tackler’s contact technique proficiency were assessed using standardised contact technique criteria, advocated by the Rugby Video Analysis Consensus Group. The criteria are split into three phases – pre-contact, contact, and post-contact. One point was awarded for each observed technique in each phase of play and totalled for each phase, and for an overall contact proficiency score. ResultsTackler technique scores were significantly lower than ball-carrier technique proficiency scores in tackler injury events, particularly in the pre-contact and post-contact phases. No significant differences were observed in ball-carrier injury events, and ball-carrier technique proficiency was significantly lower than tackler technique in the team controls non-injury tackle events. ConclusionsPoor pre-contact tackler technique increases a tackler’s risk of injury. Emphasis should be placed on this phase of contact in training to improve player safety.

BackgroundAfter anterior cruciate ligament reconstruction (ACLR), jump tests allow return to sport decision making and may help assessing anterior cruciate ligament injury iterative risk.ObjectiveThe main objective was to examine countermovement jump (CMJ) measures to identify which parameters can best distinguish between ACLR and control participants. The secondary objective was to determine whether performance alterations between operated and non-operated limb exist during CMJ after ACLR.DesignNon randomized, single blinded, prospective case control studySettingClinical studyPatientsThis study included 67 patients (ACLR group) with hamstring graft and no contact injury at 6 postoperative months and 47 healthy athletes (control group) with no knee injury history.InterventionsParticipants were performed 3 CMJ. The best performance was kept for the analysis, while landing on the force plate.Main Outcome MeasurementsThe evaluation of CMJ by force plate was performed to calculate limb symmetry index (LSI) for vertical ground reaction force (vGRF), maximal power (MP) and eccentric rate force development (RFDe) during landing. First analysis compared LSI vGRF, LSI MP and LSI RFDe between both groups. Secondary analysis compared vGRF, MP and RFDe between operated/non-operated limb in the ACLR group and dominant/non-dominant limb in the control group.ResultsAt 6 postoperative months, CMJ measures in the ACLR group were significantly reduced compared to the control group for LSI vGRF (p < 0,001), LSI MP ( p < 0,001) and LSI RFDe ( p < 0,001). Secondary analysis showed no significant result in control group. ACLR group showed significant results for vGRF (p < 0,001), MP (p < 0,001) and RFDe (p < 0,01). ConclusionsThe results indicate significant alterations on the non-operated limb during CMJ. Landing and deceleration should be better considered at time to return to sport after ACLR.

Background Recent evidence has identified a ~2-fold elevated risk of musculoskeletal injury (MSKI) in the year following a concussion. Individual factors have generally been unsuccessful in identifying athletes at elevated MSKI risk. ObjectiveTo develop a risk profile for post-concussion MSKIDesignProspective and longitudinal. SettingCollegiate Athletics in the United StatesParticipantsWe tracked 66 student-athletes (35 F, 31 M; Age: 20.0 + 1.1 y.o., Ht: 174.9 + 11.0 cm, Wt: 78.7 + 20.9 kg) for one year following a concussion.Assessments of Risk FactorsWe recorded common data elements from concussion management and categorized them into Balance, Cognition, Vestibular, and Psychosocial measures. We applied a sufficient dimension reduction statistical model to identify a composite risk score for athletes who experienced a subsequent MSK (N=36) and no subsequent MSK (N=30). Main Outcome MeasuresMSKI was defined as any injury recorded by the athletic training or team physician which resulted in at least one day of limited participation. An independent samples t-test compared a normalized composite risk score between subsequent MSK injured vs uninjured. An ROC analysis was performed on the composite scores.Results There was a significant difference in the normalized composite score between groups (No-MSKI: 4.1 + 3.2 and MSKI -5.5 + 2.9, p=0.042) with a lower score indicating worse overall performance. The highest ROC value (0.72) came from a combination of ImPACT Motor Speed and the Trail Making Test-A. Abstract 885 Figure 1ConclusionsThere is strong evidence in the literature for an elevated risk of post-concussion MSKI; however, prediction models have been unsuccessful. The results of this study provide initial evidence that a model combining assessments can differentiate those who experience subsequent MSKI. Future studies need to incorporate additional measures (e.g., medical history, sex, injury characteristics) and may allow health care providers to target athletes at the highest injury risk.

BackgroundDespite growing interest in the long-term effects of head acceleration events (HAE) in rugby union (RU) and league (RL), current match exposure guidelines are based on research surrounding injuries. Objective1) Estimate the expected number of collisions from match event data (video analysis) and HAEs (instrumented mouthguards; iMGs) per full game equivalent (FGE) played. 2) Evaluate the impact of different FGE limits on the number of collisions and HAEs. DesignRetrospective cohort SettingProfessional men’s RU (1/9/2021–31/7/22) and RL (1/1/2022–1/12/22). ParticipantsRU: 598 players (347 forwards, 251 backs); RL: 365 players (183 forwards, 182 backs). Assessment of Risk FactorsThe number of FGEs (total playing time in minutes divided by 80) for each player and positional group (forward or back) were used as independent variables to estimate expected collision and HAE counts. Main Outcome MeasurementsThe total number of collisions were derived for each player by summing individual collision counts using match event data. HAE counts were estimated at four arbitrary HAE thresholds by multiplying individual collision event counts by the probability of a HAE above the threshold for that event. ResultsIn RU and RL, forwards were involved in more collisions than backs per FGE. As the magnitude of HAE increased, the differences between forwards and backs reduced (e.g., 30 FGE RU forwards vs. RU backs; collisons 1674 [95% CI; 1663–1686] vs. 616 [602–625]; >20g HAE 169 [167–172] vs. 105 [103–108]). To reduce the number of collisions or >20g HAEs for 5% of players with the highest exposure, FGE limits would need reducing by 23% and 13% in RU or 24% and 10% in RL. ConclusionsUsing match event and iMG data has the potential to inform future match exposure exposure limits in rugby by providing expected collision and HAE counts for a variety of scenarios.

BackgroundPatellofemoral pain (PFP) is common in cyclists, but factors associated with PFP in cyclists have not been well studied.ObjectivesThe study aimed to identify factors (lower limb functional and frontal plane knee kinematic variables) associated with PFP in cyclists. DesignMatched case-control.SettingSEMLI Biomechanics laboratory, South Africa.Participants38 recreational cyclists comprising of a PFP group (clinically diagnosed) (n=19) (PFP injured limb vs. PFP uninjured limb), and a matched CON group (n=19) (PFP injured limb vs. CON limb).Assessment of risk factorsSelected lower limb functional tests (flexibility, muscle strength and endurance) and frontal plane knee kinematic variables [medio-lateral deviation (◦) during the downstroke of cycling] were explored.Main outcome measurementsThe association between PFP and the following factors: lower limb functional test variables and knee deviation [degrees of abduction or adduction] in relation to the foot, in the frontal plane. ResultsThere were no significant differences between PFP injured limb vs. CON limb for lower limb functional test variables: sit-and-reach test (p=0.1819), quadriceps flexibility (p=0.5578), one-legged hop test (p=0.0835), standard step-down test (p=1.000), lateral step-down test (p=0.3223), single-leg squat (p=0.6414), step-down test (30sec, max repetitions)(p=0.6373), single-leg squat (30sec, max repetitions)(p=0.4733). Medial deviation (°) during the downstroke was significantly greater in the CON limb vs PFP injured limb at 50° (p=0.0421), 60° (p=0.0402), 100° (p=0.0141), 110° (p=0.0143) and 120° (p=0.0402). The magnitude of significant differences between the CON limb vs. PFP injured limb varied between 0.7°-2.5°.ConclusionThere was no association between lower limb functional test variables, nor frontal plane knee kinematic variables, and PFP. This study adds to the limited body of knowledge on the mechanisms and risk factors associated with PFP in cyclists. This area requires substantial more research to aid clinicians in the pursuit of injury prevention strategies for cyclist with PFP.

BackgroundLateral ankle sprains are one of the most common sports injuries. The intervention ‘Strengthen your ankle’ to prevent recurrent ankle sprains is developed and implemented since 2009, but current implementation success is unknown.ObjectiveTo evaluate current implementation success of ‘Strengthen your ankle’ , and to gain insight in intermediaries and end-users needs for improvements. DesignIn 2022 a quantitatively process evaluation took place via online questionnaires. SettingThe process evaluation was conducted among intervention users and relevant intermediaries. Also, Google analytics were used. Participants181 users and 184 intermediaries. Intervention‘Strengthen your Ankle‘ is an intervention consisting of a proven (cost) effective exercise program for the prevention of secondary ankle injuries, and available in an free App (IOS/Android), and fold-out card. Main outcome measurementsRE-AIM framework was used to evaluate the app. Reach was defined as number of downloads of the app since January 2018, effectiveness as satisfaction with the intervention, adoption as frequency of use, implementation as barriers and facilitators of use and maintenance as intention of/recommendation for future use. Results129,300 downloads were counted in 66 months (Jan 2018-Jul 2023), on average 1960 downloads per month. The app received an average score of 8. The IOS app has been used at least 173,000 times, the Android app 85,250 times. The user data of the Android app is however incomplete. Furthermore, 70% expect to suffer an ankle injury less quickly in the future due to the app. Satisfaction with the exercises is high. But the design of the app is outdated. Almost all patients would recommend the app (93%). Of the intermediaries familiar with the app, 70% have used the app to prevent recurrent ankle ligament injuries in athletes.Abstract 757 Figure 1ConclusionThe Intervention ‘Strengthen your Ankle’ is still widely used and positively assessed 10 years after development.

BackgroundTrail running, a popular off-road sport, involves running in natural environments over various terrains, often in remote locations.ObjectivesTo investigate the prevalence, nature and risk factors (RFs) of medical encounters (MEs), i.e. injuries and illnesses, among trail runners on race-day. DesignDescriptive cross-sectional study.Setting2020 SkyRun trail race (38km, 65km and 100km distances), South Africa. Patients or Other ParticipantsConsenting trail runners ≥18 years (n=285; 86.1%).AssessmentThe medical team on race-day captured all MEs. An ME is defined as a race participant presenting to the medical team with an illness or injury sustained from the official start up to 24 hours after the official cut-off time.Main Outcome Measure(s Data included demographic details, injuries (body region, specific body area, tissue type, pathology) and illnesses (organ system, symptom cluster, aetiology). RFs included sex, age, weight, height, race distance, illness and injury history, training and running experience. Frequency (n,%), prevalence (%) and odds ratios (OR; 95%CI) are reported.ResultsEighty-nine (31.2%) individuals reported 131 MEs [49 injuries (37.4%); 82 illnesses (62.6%)]. Prevalence of injuries was 14.7%, and of illnesses, 22.5%. The lower limb was mainly involved (83.7%), specifically the foot (36.7%), ankle (20.4%) and knee (14.3%). Tissue types involved skin (42.8%), ligament (14.3%) and muscle (14.3%). Illness affected multiple (54.9%) and gastrointestinal (20.7%) organ systems. Only 100km runners reported dehydration (31.5%), and 1 in 6 of these runners (17.9%) did not finish (DNF). Runners reporting fatigue (23.6%) had a high DNF rate (61.9%). Also, 2 in every 5 participants (40.4%) reporting an ME DNF. No ME-associated RFs identified. ConclusionsIllness MEs were more common than injury MEs during the 2020 SkyRun race. Sustaining an ME increased the chance of not completing the race. Further research is required to assist in developing strategies to prevent race-day adverse events.

BackgroundRingette is a popular female team ice-sport in Canada, USA, Scandinavia, and Czech Republic. Although bodychecking (i.e., intensive contact with another player to remove them from offensive control of play) is prohibited, high rates of bodychecking and suspected-injury have been reported based on video-analysis. Understanding injury and concussion rates in adolescent ringette is crucial for improving player safety.ObjectiveTo examine injury and concussion rates and types in adolescent ringette (ages 11–18).DesignCohort study.SettingCanadaParticipantsYouth ringette players in Calgary participating in three age divisions (under-14[U14], under-16[U16], under-19[U19]) during the 2022–23 season. Assessment of Risk FactorsInjury and concussion incidence rates (IR) were examined across three age groups.Main Outcome MeasurementsInjuries included were all complaint injuries. Poisson regression (cluster-adjusted by team) estimated injury and concussion rates (IR=#injuries/100 players/season), with incidence rate ratios (IRR) comparing IRs by age group. Injury types, player position, mechanisms, and median time-loss are reported.ResultsThe overall injury-IR was 35.88/100 players/season (95%CI: 27.45–46.91) and concussion-specific IR was 12.94/100 players/season (95%CI: 8.42–19.89). Compared to U14(IR=27.27/100 players/season,95%CI;14.47–51.42), U16(IR=27.85,95%CI;17.65–43.94) had similar injury-IRs (IRR[U16vsU14]=1.02,95%CI;0.47–2.22) and U19(IR=64.86,95%CI;44.61–94.31) had higher injury-IRs (IRR[U19vsU14]=2.38,95%CI;1.15–4.93). The median time-loss for concussions was 18 days (IQR:20) and non-concussions was 7 days (IQR:13). Head and neck injuries were most common (40%), followed by knee (23%). Forwards sustained the greatest proportion of concussions (59%) and non-concussions (50%) reported. Game-related concussions (91%) and non-concussions (77%) accounted for most injuries, compared to practice-related. Unintentional player-contact was the primary concussion mechanism (55%). Intentional player contact (26%), unintentional player-contact (26%), and contact with the environment (26%) were the primary mechanisms reported for non-concussion injuries. ConclusionInjury and concussion rates are high among adolescent ringette players in Canada, the highest in U19 players. Continued efforts to enhance player safety and prevent injuries in ringette are needed.

BackgroundMany existing studies have shown that the biggest risk factor for future injury is previous medical history. Understanding the patterns between injuries and subsequent injuries can help inform strategic and individual prevention measures.ObjectiveTo apply a theoretical model of subsequent injury classification to real-world data and determine what types of subsequent injury happen after an initial injury. DesignRetrospective cohort study.SettingUK summer Olympic sports. Participants3,801 full-time Olympic sport athletes (1,895 men, 1,906 women).InterventionsThere were no interventions.Main Outcome MeasurementsPrevalence of subsequent injury, classified by body region, pathology, and structure of the next subsequent injury to each previous injury.ResultsFrom 17,139 initial injuries, 10,947 1 (63.9%) had a subsequent time-loss injury within one year. Of those subsequent time-loss injuries, 5.5% (577) were a repeat of the initial injury (same side, structure and pathology), 10.3% (1,091) of subsequent injuries were to the same body region but a different pathology or structure, and 87.7% (9,279) of subsequent injuries were to a different body region.Generally, body regions that had higher incidence of injury also had higher prevalence of subsequent injuries to the same region. Injuries to the lumbar/pelvis had the highest prevalence of subsequent repeated re-injury (4.9% of lumbar/pelvis injuries had repeated re-injury) and elbow injuries had the lowest prevalence of subsequent repeated re-injury (1.1% of elbow injuries). Thigh had the highest prevalence of subsequent injuries to the same region without repeated re-injury (10.5% of thigh injuries). Abdomen injuries had the highest prevalence of subsequent injuries to a different body region (64.3%).ConclusionsThe theoretical model can be successfully applied automatically to real-world data. This information can used to influence injury prevention and rehabilitation strategies and to explore whether there are opportunities to improve prevention of subsequent injuries of the same, or similar, types.

BackgroundRecent research showed that currently accepted RTS criteria do not sufficiently identify patients at risk for an ACL reinjury. Interestingly, many of the sports where the ACL (re)injury is high, are characterized by sudden, sometimes unforeseen, changes in direction and constant attention to the environment is paramount. With the help of Virtual Reality (VR), sport-specific life-like situations can be created, shifting the athlete’s focus to the VR game instead of the injured knee. Therefore, VR guided RTS screening could be more suited to detect residual functional kinematic deficits after ACLR.ObjectiveTo investigate the effect of VR on movement quality during RTS evaluation in male football players after ACLR compared to the healthy matched controls. DesignA kinematic case-control study.SettingAll participants performed a kinematic RTS testing in which cutting and header maneuvers were evaluated in both VR and non-VR guided settings.PatientsForty male football players were included (20 ACLR patients, 20 healthy matched controls). Assessment of risk factorsThe kinematic testing was conducted in a VR situation, where the participants wore a head mounted display and a non-VR situation, where Reaction Lights were used. Main outcome measurementsKnee angles were calculated, with particular focus on the ground-contact phases during the cutting and landing tasks. ResultsThe VR condition showed more flexion (average p = 0.044) and adduction (average p = 0.029; maximal p = 0.012) during the push-off phase of the side cutting maneuver. Also, only the VR condition was able to identify bilateral differences, sparing the affected leg during landing (p = 0.016).ConclusionThe biomechanical risk profile for (re)injury was more provoked during VR screening, probably due to the external focus of attention through immersion. So, although still in its infancy, VR seems to be promising to incorporate for screening purposes.