Robert C Lynall1,2, Brian Pietrosimone3,4,2, Zachary Y Kerr5, Timothy C Mauntel4,2, Jason P Mihalik1,2, Kevin M Guskiewicz1,2. 1. Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center. 2. Curriculum in Human Movement Science, Department of Allied Health Sciences, University of North Carolina at Chapel Hill. Dr Lynall is now at the Concussion Research Laboratory, Department of Kinesiology, The University of Georgia, Athens. Dr Mauntel is now at Walter Reed National Military Medical Center, Department of Orthopaedics, Bethesda, MD. 3. Neuromuscular Research Laboratory. 4. Sports Medicine Research Laboratory. 5. Department of Exercise and Sport Science, and.
Abstract
CONTEXT: Dynamic balance deficits have been described postconcussion, even after athletes return to play. Lower extremity (LE) musculoskeletal injury rates increase for up to 1 year after concussion, but the long-term musculoskeletal implications of concussion are unclear. OBJECTIVE: To (1) examine the association of concussion and LE injury histories with osteoarthritis (OA) prevalence in retired National Football League players and (2) examine the association of concussion and LE injury histories with OA prevalence in those ≤55 years of age. DESIGN: Case-control study. SETTING: Survey. PATIENTS OR OTHER PARTICIPANTS: We administered the Health Survey of Retired National Football League Players, which collects information about demographics, OA, LE injury, and concussion history. MAIN OUTCOME MEASURE(S): Twelve discrete categories were created based on concussion and LE injury history, ranging from 0 concussions and 0 LE injuries (referent group) to 3+ concussions and 2+ LE injuries. Binomial regression analysis modeled lifetime OA prevalence. Covariates were body mass index, age at the time of the survey, and total years playing professional football. RESULTS: Complete data were available for 2696 participants. Lifetime OA prevalence was smallest in the referent group (21.1%) and largest in the 3+ concussion and 2+ LE group (50.6%; 2.5 times the referent; 95% confidence interval [CI] = 2.1, 3.1). Participants in all concussion groups (1, 2, 3+) who reported a history of 0 LE injuries had a greater OA prevalence than the referent group. When participants were stratified by age, the ≤55 years of age, 3+ concussions, and 2+ LE injuries group prevalence ratio (3.6; 95% CI = 2.7, 5.2) was larger than that of the >55 years of age, 3+ concussions, and 2+ LE injuries group (1.8; 95% CI = 1.3, 2.4) compared with the respective referent groups. CONCLUSIONS: Concussion with or without a history of LE injury may be an important moderator of OA. Future researchers should seek to better understand the mechanisms that influence the association among concussion, LE injury, and OA.
CONTEXT: Dynamic balance deficits have been described postconcussion, even after athletes return to play. Lower extremity (LE) musculoskeletal injury rates increase for up to 1 year after concussion, but the long-term musculoskeletal implications of concussion are unclear. OBJECTIVE: To (1) examine the association of concussion and LE injury histories with osteoarthritis (OA) prevalence in retired National Football League players and (2) examine the association of concussion and LE injury histories with OA prevalence in those ≤55 years of age. DESIGN: Case-control study. SETTING: Survey. PATIENTS OR OTHER PARTICIPANTS: We administered the Health Survey of Retired National Football League Players, which collects information about demographics, OA, LE injury, and concussion history. MAIN OUTCOME MEASURE(S): Twelve discrete categories were created based on concussion and LE injury history, ranging from 0 concussions and 0 LE injuries (referent group) to 3+ concussions and 2+ LE injuries. Binomial regression analysis modeled lifetime OA prevalence. Covariates were body mass index, age at the time of the survey, and total years playing professional football. RESULTS: Complete data were available for 2696 participants. Lifetime OA prevalence was smallest in the referent group (21.1%) and largest in the 3+ concussion and 2+ LE group (50.6%; 2.5 times the referent; 95% confidence interval [CI] = 2.1, 3.1). Participants in all concussion groups (1, 2, 3+) who reported a history of 0 LE injuries had a greater OA prevalence than the referent group. When participants were stratified by age, the ≤55 years of age, 3+ concussions, and 2+ LE injuries group prevalence ratio (3.6; 95% CI = 2.7, 5.2) was larger than that of the >55 years of age, 3+ concussions, and 2+ LE injuries group (1.8; 95% CI = 1.3, 2.4) compared with the respective referent groups. CONCLUSIONS: Concussion with or without a history of LE injury may be an important moderator of OA. Future researchers should seek to better understand the mechanisms that influence the association among concussion, LE injury, and OA.
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