Lower Back Symptoms in Adolescent Soccer Players: Predictors of Functional Recovery.

BACKGROUND: There are little published data on factors relating to low back pain in the younger athletic population. HYPOTHESIS: Independent predictors of recovery and return to participation in sports could be determined by event analysis, which investigates the impacts of covariates, including age, position, and injury type, on the risk of delayed recovery after injury. STUDY DESIGN: Descriptive epidemiology study. METHODS: This study examined 41 English Premiership soccer academy squads consisting of 12,306 player seasons for the incidence of lower back injury, injury severity, and investigated time to recovery in relation to potential risk factors. Injury risk was assessed for different times in a match and season, mechanism of injury, player position, player age, and competitive compared with noncompetitive play. RESULTS: A total of 310 (3.0% of all injuries sustained in the population) lumbar spine injuries were recorded. Overall, 10,265 training days (median, 14 days; interquartile range, 8-30 days) were lost. The risk of injury increased as the first half progressed and was maintained throughout the second half with a contact mechanism and with increasing age. Neither competitive play compared with noncompetitive play nor player position had an effect on injury incidence. Prognostic factors for poor recovery were bony injuries and increasing age. CONCLUSION: These findings indicate that prolonged absence from training after a back injury is seen, especially in bony injuries and in older adolescents. It is suggested that there should be a low threshold for investigation of adolescent patients with back pain in the hope of early appropriate management of more severe diagnoses.

English Premiership Academy knee injuries: lessons from a 5 year study.

This study addresses the epidemiology of knee injuries in adolescent males. Data were collected prospectively from 41 Premiership soccer academies over a 5 year period from July 2000 to June 2005. A total of 12,306 player seasons were registered in the U9 to the U16 age categories with a total of 1750 recordable injuries specific to the knee joint. There was a mean incidence of 0.71 (95% confidence interval ± 0.05) knee injuries per player per year, and a median of 17 (inter-quartile range 9-38) training days and 2 (inter-quartile range 1-4) matches missed per knee injury. Knee injuries were found to be most common in the 14-16 year age group. Six hundred and nine (35% of total) injuries were classed as severe resulting in more than 28 days' absence. Injuries were more likely to be sustained in a competitive or match-play environment (862 or 52%) than in training (796 or 48%), and a non-contact mechanism was implicated in 823 (55%) of recorded cases. Peaks in injury numbers were seen in early season and subsequent to the winter break. Sprain was the most common diagnosis recorded, with the medial collateral ligament affected in 23% of all knee injuries. Knee injuries are common in elite youth footballers. In this uninsured age group, it could be argued that earlier medical intervention may reduce long-term damage to the immature skeleton.

Ankle injuries in football academies: a three-centre prospective study.

BACKGROUND: Injuries are common in youth soccer, of which ankle injuries form a significant proportion. However, there is a lack of prospective data on the epidemiology and nature of these injuries. AIM: To prospectively study the incidence of ankle injuries in three Football Association (FA) academies, with particular emphasis on severe injuries and factors associated with increased injury rate. DESIGN: Descriptive epidemiology study. METHODS: All 419 players within three FA youth academies during the 2007-2008 season were included, between under 9 and under 18 age groups. Ankle injuries causing a loss of more than 48 h training were studied, along with the setting and mechanism of injury, the diagnosis, time to rehabilitate, any investigations and surgical treatment. The incidence of injury per 1000 h exposure in match, training and in total was calculated. RESULTS: A total of 56 (incidence 14%) new ankle injuries were identified during this 1-year study period. Twenty-six (46%) of these occurred in competition, 24 (43%) were by contact, and eight (14%) had a severe injury diagnosed. The incidence was higher in the competitive setting. Ten injuries (18%) missed more than 6 weeks' training. Of these, seven were diagnosed as 'sprain' or 'strain,' of whom only three had been further investigated. There was a significant relationship between injury incidence and age group for total and match exposure, but not for training exposure. CONCLUSIONS: The incidence of ankle injury in youth soccer is higher in competition, and increases with age in competition. 17.5% of ankle injuries missed more than 6 weeks' training, but the authors found a subgroup of players with delay in returning to sport in whom there was no further investigation to establish the diagnosis. This group may harbour occult injury to the chondral surfaces, and earlier investigation could minimise secondary joint damage in this 'at risk' age group.

284 press-fit Kinemax total knee arthroplasties followed for 10 years: poor survival of uncemented prostheses.

BACKGROUND AND PURPOSE: Our institution began using the Kinemax total knee arthroplasty system in 1988, both with and without cement fixation. We report 10-year survival figures. METHODS: Theater records showed that 284 Kinemax total knee arthroplasties had been performed 1988 through 1993. Life-table survival estimates were used to determine the probability of survivorship 10 years after surgery for the total group and by age, sex, diagnosis, and mode of fixation. Median follow-up was 11 (0.8-15) years for unrevised knees in patients who were still alive. RESULTS: The 10-year cumulative survivorship was higher (93%, 95% CI: 81-97) when both components had been cemented than if either, or both, were uncemented (77%, CI: 67-83; p < 0.001). There was an increased incidence of failure in patients who were less than 60 years of age at the time of surgery (p = 0.004). INTERPRETATION: The smooth-backed Kinemax knee without cement was found to be associated with a high failure rate at 10 years. The 10-year cumulative survival results of the cemented prosthesis are acceptable.

A pilot randomized, controlled trial of treatment for painful arc of the shoulder.

There is a lack of evidence about the efficacy of routinely used interventions in shoulder pain, such as corticosteroid injection and physiotherapy. This pilot study was set up to assess the feasibility of a larger, randomized controlled trial. Patients with the clinical presentation of a painful arc of less than 6 months' duration were recruited through their general practitioners. A total of 112 patients were randomized to 4 groups: control, physiotherapy, a course of subacromial steroid injections, or both physiotherapy and steroid injections. The primary outcome measure was the Oxford Shoulder Score (OSS). Follow-up was 18 weeks and by postal questionnaire at 1 year. No significant differences were found within groups between the OSS scores or the Physical Health total of the Medical Outcomes Study Short Form 36 (SF-36) Health Survey at the beginning and end of the trial or at 1 year. By analysis of covariance, no significant differences were found between treatment groups. Larger studies are needed. A power calculation from our data suggests recruitment of more than 800 patients would be required to achieve a 90% chance of a clinically significant difference being detected between these groups.