Decision making in the Contact athlete
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Transcript of Decision making in the Contact athlete
Lennard FunkWrightington Upper Limb UnitSalford University
CONTACT ATHLETESDECISION MAKING
Sport Popularity in UKSPORT TV Viewing Participation InterestFootball 46% 10% 45%Rugby Union 21% 6% 27%Tennis 18% 3% 23%Cricket 18% 2% 19%Athletics 18% 2% 21%Snooker 17% 5% 24%Motorsport 16% NA 20%Rugby League
12% 2% 15%Boxing 11% NA 14%Golf 11% 6% 16%
My Elite Athletes (2010-2013) = 663
SPORT Percent Commonest Path.Rugby Union 37% (247) Anterior Labral
Rugby League
28% (182) Posterior LabralFootball/Soccer
8% (54) Anterior LabralMotorsport 3% (22) Mixed Labral
TearsClimbers 3% (20) SLAPSwimming 3% (18) Int Imping/
SLAPCricket 2% (14) Anterior LabralParalympics 2% (13) Mixed Labral
TearsOthers 14% (93)
Three P’s
Patient
Pathology Participation
1. Age 2. Gender 3. Laxity 4. Fatigue 5. Sport 6. Position
1. Major 1. Bony 2. ALPSA 3. HAGL 4. FTCT
2. Minor 1. Labral 2. PTCT
1. Season 2. Events 3. Pressure 4. Age
Recurrent Instability Rates (after arthroscopic stabilisation)
[Cho et al. Arthroscopy 2006]
CONTACT / COLLISION
OVERHEADFLEXIBILITY
29%
7%
Recurrent Instability Rates in Contact Sports
• Non-operative = 80% [Arciero, 1994]
• Open Bankart repair = 12%• Arthroscopic Stabilisation = 14% [Larrain,
2006]
– First dislocation = 4%– Recurrent dislocations = 24%– Under 18yrs age = 30% [Nixon & Funk, 2013]
• RCT of Latarjet vs. Arthroscopic Bankart• Recurrence rate at 5 years:
– Latarjet = 12%– Arth. Bankart = 24%
• Return to sport the same!• Complication Rates higher (20%)
Latarjet Procedure [Bessier et al. JOST. 2013]
Recurrence Summary• Higher in contact/collision sport• Higher in young• Higher after surgery for recurrent
dislocations
• Arthroscopic = Open Bankart• Lower after Latarjet procedure
WHY?
PATIENT
Predisposing Factors• Player:
1.LaxityCheng et al. JBJSB 2007; Akhtar & Robinson. BJSM 2010
2.Proprioception Herrington, 2011
3.Isokinetics Jones & Funk, 2010
4.Mass5.Running Speed6.Aerobic ability7.Previous Injury
• Sport:
1. Speed of play
2. Timing
3. Fatigue
1. Physical
2. Mental
Injury Reduction Predispostion Model Meeuwisse
PATHOLOGY
Pathology
Mechanisms of Injury video analysis study
Direct Impact
Complex Labral
Bony Bankart PTCT
Flexed Fall
Posterior Labral
RHAGL
Try Scorer
Bankart SLAP
Rotator Cuff
Tackler
Bankart SLAP HAGL
Crichton, Jones & Funk - BJSM 2012
Player Position
• 25 Professional Footballers– 15 Field players– 10 Goalkeepers
Funk & Sargent, 2010
Injury Patterns
Clinical Examination: Instability in Athletes
• True Instability– Dislocation– Subluxation– Apprehension– Large lesions
• Subclinical Instability– Dead Arm in ABER– Pain in ABER– Clunking– No Apprehension– Smaller lesions
Investigations• No previous Surgery = MR Arthrogram
• Previous Surgery = CT Arthrogram
MR Arthrogram v. Scope
Sensitivity Specificity Accuracy
SLAP 0.42 0.92 77%
Rotator Cuff Tear
0.50 0.86 83%
Hill Sachs 0.91 0.78 90%
Bankart 0.85 0.83 86%
N Karlson, J Geoghan, L Funk; 2008
• An experienced Shoulder Surgeon better
• Can correlate with clinical context• Experience of reviewing Scopes & Scans
Pathology
Major ‘Minor’
• Bony Bankart• ALPSA• Rotator Cuff Tear• HAGL
• Undisplaced Labral Tear• Partial Cuff Tear
Timing of Surgery (Participation)
• Early Surgery:
– Large structural lesions
– Late in Season
– Unable to Return
• Rehab & Return:
– Minor lesions
– Early season
Types of Surgery• Mostly Arthroscopic Direct Repairs• Latarjet for High-Risk/Revision
• Anterior Instability– Revision surgery (even without bone loss)– Chronic Bony Bankart (> 3months)– Any Bony Glenoid Loss– True dislocation in Front Row forward
(Rugby Union)
– Higher level of sports
Latarjet in Athletes
Three P’s
Patient
Pathology Participation
1. Age 2. Gender 3. Laxity 4. Fatigue 5. Sport 6. Position
1. Major 1. Bony 2. ALPSA 3. HAGL 4. FTCT
2. Minor 1. Labral 2. PTCT
1. Season 2. Events 3. Pressure 4. Age
THANK YOU