Trends in concussion incidence in high school sports: a prospective 11-year study.

BACKGROUND: Understanding the risk and trends of sports-related concussion among 12 scholastic sports may contribute to concussion detection, treatment, and prevention. PURPOSE: To examine the incidence and relative risk of concussion in 12 high school boys' and girls' sports between academic years 1997-1998 and 2007-2008. STUDY DESIGN: Descriptive epidemiology study. METHODS: Data were prospectively gathered for 25 schools in a large public high school system. All schools used an electronic medical record-keeping program. A certified athletic trainer was on-site for games and practices and electronically recorded all injuries daily. RESULTS: In sum, 2651 concussions were observed in 10 926 892 athlete-exposures, with an incidence rate of 0.24 per 1000. Boys' sports accounted for 53% of athlete-exposures and 75% of all concussions. Football accounted for more than half of all concussions, and it had the highest incidence rate (0.60). Girls' soccer had the most concussions among the girls' sports and the second-highest incidence rate of all 12 sports (0.35). Concussion rate increased 4.2-fold (95% confidence interval, 3.4-5.2) over the 11 years (15.5% annual increase). In similar boys' and girls' sports (baseball/softball, basketball, and soccer), girls had roughly twice the concussion risk of boys. Concussion rate increased over time in all 12 sports. CONCLUSION: Although the collision sports of football and boys' lacrosse had the highest number of concussions and football the highest concussion rate, concussion occurred in all other sports and was observed in girls' sports at rates similar to or higher than those of boys' sports. The increase over time in all sports may reflect actual increased occurrence or greater coding sensitivity with widely disseminated guidance on concussion detection and treatment. The high-participation collision sports of football and boys' lacrosse warrant continued vigilance, but the findings suggest that focus on concussion detection, treatment, and prevention should not be limited to those sports traditionally associated with concussion risk.

Effect of suture size and type on bone cutout in transosseous tendon repairs.

PURPOSE: We compared bone cutout of polyester and polyblend suture in 2 suture sizes with static and cyclic loading in a Sawbone model (Pacific Research Laboratories, Vashon, WA). METHODS: Polyester and polyblend sutures in both No. 2 and No. 5 sizes were placed through transosseous tunnels in closed-cell polyurethane foam and tied over the bar of an electromechanical load frame at a fixed height. Seven sutures in each group were pulled at a rate of 1 mm/s until bone cutout occurred. Another set of 28 sutures were cyclically loaded at increasing loads until failure. RESULTS: With static and cyclic loads, No. 5 polyester suture (Ethibond; Ethicon, Somerville, NJ) and No. 5 polyblend suture (FiberWire; Arthrex, Naples, FL) had a higher cutout load than the No. 2 sutures (P < .001). No. 2 polyblend suture had a higher static failure load than No. 2 polyester suture (P = .02). With cyclic loading, No. 2 polyblend suture had a higher load to cutout than No. 2 polyester suture (P = .01), and No. 5 polyblend suture had a higher load to cutout than No. 5 polyester suture (P = .003). CONCLUSIONS: No. 2 sutures showed bone cutout at lower forces under static and cyclic loading as compared with No. 5 sutures in this Sawbone model, and no decrease in performance with regard to bone cutout was noted with polyblend as compared with polyester. CLINICAL RELEVANCE: No. 5 polyester or polyblend suture may be preferable to No. 2 suture to avoid bone cutout in tendon-to-bone repair, and No. 5 polyblend may be preferable to No. 5 polyester to avoid bone cutout.