Kim D Barber Foss1,2, Weihong Yuan3,4,5, Jed A Diekfuss1, James Leach4,5,6, William Meehan7, Christopher A DiCesare1, Gary Solomon8, Daniel K Schneider1,9, James MacDonald10,11, Jon Dudley3, Nelson Cortes12,13, Ryan Galloway1, Mark Halstead14, Gregory Walker1,15,16,17, Gregory D Myer1,7,15,18. 1. Division of Sports Medicine, The SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 2. Rocky Mountain University of Health Professions, Provo, Utah. 3. Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 4. Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 5. Department of Radiology, College of Medicine, University of Cincinnati, Cincinnati, Ohio. 6. Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 7. The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts. 8. Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University, Nashville, Tennessee. 9. Riverside Methodist Hospital, Columbus, Ohio. 10. College of Medicine, The Ohio State University, Columbus, Ohio. 11. Sports Medicine, Nationwide Children's Hospital, Columbus, Ohio. 12. Sports Medicine Assessment, Research and Testing (SMART) Laboratory, George Mason University, Manassas, Virginia. 13. Department of Bioengineering, George Mason University, Manassas, Virginia. 14. Departments of Pediatrics and Orthopedics, Washington University School of Medicine, St. Louis, Missouri. 15. Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio. 16. Sports Medicine Center, Children's Hospital Colorado, Aurora, CO. 17. Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO. 18. Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio.
Abstract
OBJECTIVE: Youth athletes are believed to be more susceptible to white matter (WM) degradation resulting from head impact exposure relative to high school (HS) athletes; this hypothesis has not been objectively tested. The purpose of this study was to determine preseason to postseason changes in WM integrity from repetitive head impacts for youth football (YFB) players compared with HS football players during a competitive football season. DESIGN: Prospective cohort. SETTING: One season of YFB (grades 7 and 8) and varsity HS football (grades 10-12). PATIENTS OR OTHER PARTICIPANTS: Twelve YFB (13.08 ± 0.64 years) and 21 HS (17.5 ± 0.78 years) athletes. INTERVENTIONS: Participants completed 2 magnetic resonance imaging sessions: preseason and postseason. Head impact exposure was recorded during practice and games using a helmet-mounted accelerometer. MAIN OUTCOME MEASURES: Tract-based spatial statistics were used to evaluate group differences in preseason to postseason changes in diffusion tensor imaging, including fractional anisotropy and mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). RESULTS: The HS group exhibited significant preseason to postseason reductions in MD, AD, and RD (P < 0.05, corrected) in widespread WM areas. Significant WM reductions for the YFB group were only observed for AD (P < 0.05, corrected), but was more limited in extent compared with HS. CONCLUSIONS: Significant preseason to postseason AD reduction was found in both YFB and HS groups after one season of competitive play. Our results did not confirm recent speculation that younger children are more susceptible to the deleterious effects of repetitive head impacts compared with their older counterparts.
OBJECTIVE: Youth athletes are believed to be more susceptible to white matter (WM) degradation resulting from head impact exposure relative to high school (HS) athletes; this hypothesis has not been objectively tested. The purpose of this study was to determine preseason to postseason changes in WM integrity from repetitive head impacts for youth football (YFB) players compared with HS football players during a competitive football season. DESIGN: Prospective cohort. SETTING: One season of YFB (grades 7 and 8) and varsity HS football (grades 10-12). PATIENTS OR OTHER PARTICIPANTS: Twelve YFB (13.08 ± 0.64 years) and 21 HS (17.5 ± 0.78 years) athletes. INTERVENTIONS:Participants completed 2 magnetic resonance imaging sessions: preseason and postseason. Head impact exposure was recorded during practice and games using a helmet-mounted accelerometer. MAIN OUTCOME MEASURES: Tract-based spatial statistics were used to evaluate group differences in preseason to postseason changes in diffusion tensor imaging, including fractional anisotropy and mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). RESULTS: The HS group exhibited significant preseason to postseason reductions in MD, AD, and RD (P < 0.05, corrected) in widespread WM areas. Significant WM reductions for the YFB group were only observed for AD (P < 0.05, corrected), but was more limited in extent compared with HS. CONCLUSIONS: Significant preseason to postseason AD reduction was found in both YFB and HS groups after one season of competitive play. Our results did not confirm recent speculation that younger children are more susceptible to the deleterious effects of repetitive head impacts compared with their older counterparts.
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