J Knee Surg 2020; 33(07): 666-672
DOI: 10.1055/s-0039-1683953
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Knee Ultrasonography to Determine Risk for Noncontact Injuries in Collegiate American Football Players

Ryan A. Lewis
1   Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
2   College of Medicine, University of Florida, Gainesville, Florida
,
Cristi R. Cook
1   Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
3   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
,
Patrick A. Smith
1   Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
3   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
4   Columbia Orthopaedic Group, Columbia, Missouri
,
James P. Stannard
1   Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
3   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
,
Rex L. Sharp
5   Department of Intercollegiate Athletics, University of Missouri, Columbia, Missouri
,
Kyle M. Blecha
3   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
,
James L. Cook
1   Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
3   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
› Author Affiliations
Further Information

Publication History

06 February 2019

11 February 2019

Publication Date:
08 April 2019 (online)

Abstract

Knee ultrasonography has been used effectively as a screening tool for determining risk for knee injuries in athletes. Ultrasonography may be a valuable screening tool for relative risk of noncontact knee injuries that occur over a typical playing career in collegiate American football players. In this prospective longitudinal study, we evaluated American football players (n = 48) in an academic institution affiliated with the National Collegiate Athletic Association Division I athletic program. Players underwent comprehensive ultrasonography of both knees prior to beginning their collegiate careers. Anatomic structures were evaluated for presence and severity of abnormalities. Noncontact lower extremity injuries sustained over the collegiate career of the subjects were documented. Data were analyzed for correlations, differences in proportions, and odds ratio (OR). Seventy-nine percent of the athletes had at least one ultrasonographic abnormality, with quadriceps tendon (47.9%) and patellar tendon (39.6%) abnormalities predominating. Seventy-nine percent of players had at least one noncontact lower extremity injury (23.5% involving the knee) during their careers with an average of 2.8 injuries per career. The majority of injuries occurred in the second and third playing years. There was a significantly higher likelihood of patellar tendon injury based on the presence of patellar tendon ultrasonographic pathology (p = 0.024; OR = 11x). There was a significantly higher likelihood of quadriceps muscle–tendon injury based on the presence of quadriceps tendon ultrasonography pathology (p = 0.0012; OR = 140x). All athletes sustaining meniscal injuries had preexisting joint effusion but no preexisting ultrasonographic meniscal pathology. Knee ultrasonography along with patient history and complete physical examination may help reduce injury risk through education, prevention, and training programs.

 
  • References

  • 1 Brophy RH, Barnes R, Rodeo SA, Warren RF. Prevalence of musculoskeletal disorders at the NFL Combine--trends from 1987 to 2000. Med Sci Sports Exerc 2007; 39 (01) 22-27
  • 2 Lawrence DW, Hutchison MG, Comper P. Descriptive epidemiology of musculoskeletal injuries and concussions in the National Football League, 2012–2014. Orthop J Sports Med 2015 ;3(5):2325967115583653
  • 3 Comin J, Cook JL, Malliaras P. , et al. The prevalence and clinical significance of sonographic tendon abnormalities in asymptomatic ballet dancers: a 24-month longitudinal study. Br J Sports Med 2013; 47 (02) 89-92
  • 4 Cook JL, Khan KM, Harcourt PR. , et al; Victorian Institute of Sport Tendon Study Group. Patellar tendon ultrasonography in asymptomatic active athletes reveals hypoechoic regions: a study of 320 tendons. Clin J Sport Med 1998; 8 (02) 73-77
  • 5 Cook JL, Khan KM, Kiss ZS, Coleman BD, Griffiths L. Asymptomatic hypoechoic regions on patellar tendon ultrasound: A 4-year clinical and ultrasound followup of 46 tendons. Scand J Med Sci Sports 2001; 11 (06) 321-327
  • 6 Fredberg U, Bolvig L, Andersen NT. Prophylactic training in asymptomatic soccer players with ultrasonographic abnormalities in Achilles and patellar tendons: the Danish Super League Study. Am J Sports Med 2008; 36 (03) 451-460
  • 7 Giombini A, Dragoni S, Di Cesare A, Di Cesare M, Del Buono A, Maffulli N. Asymptomatic Achilles, patellar, and quadriceps tendinopathy: a longitudinal clinical and ultrasonographic study in elite fencers. Scand J Med Sci Sports 2013; 23 (03) 311-316
  • 8 Gisslén K, Gyulai C, Nordström P, Alfredson H. Normal clinical and ultrasound findings indicate a low risk to sustain jumper's knee patellar tendinopathy: a longitudinal study on Swedish elite junior volleyball players. Br J Sports Med 2007; 41 (04) 253-258
  • 9 Visnes H, Tegnander A, Bahr R. Ultrasound characteristics of the patellar and quadriceps tendons among young elite athletes. Scand J Med Sci Sports 2015; 25 (02) 205-215
  • 10 Cook JL, Cook CR, Stannard JP. , et al. MRI versus ultrasonography to assess meniscal abnormalities in acute knees. J Knee Surg 2014; 27 (04) 319-324
  • 11 Brimmo OA, Smith PA, Cook CR, Cook JL. Sonographic diagnosis of an acute lateral meniscus tear in a Division I collegiate American football player. J Knee Surg Rep 2015; 1 (01) 57-59
  • 12 Yanagisawa S, Ohsawa T, Saito K. , et al. Population-based study of the relationship between medial meniscus radial displacement, determined by use of ultrasound screening, and knee pain. J Orthop Sci 2014; 19 (06) 954-958
  • 13 Alves TI, Girish G, Kalume Brigido M, Jacobson JA. US of the knee: scanning techniques, pitfalls, and pathologic conditions. Radiographics 2016; 36 (06) 1759-1775
  • 14 Wang J, Wu H, Dong F. , et al. The role of ultrasonography in the diagnosis of anterior cruciate ligament injury: a systematic review and meta-analysis. Eur J Sport Sci 2018; 18 (04) 579-586
  • 15 Craft JA, Kurzweil PR. Physical examination and imaging of medial collateral ligament and posteromedial corner of the knee. Sports Med Arthrosc Rev 2015; 23 (02) e1-e6
  • 16 De Maeseneer M, Marcelis S, Boulet C. , et al. Ultrasound of the knee with emphasis on the detailed anatomy of anterior, medial, and lateral structures. Skeletal Radiol 2014; 43 (08) 1025-1039
  • 17 Gaetke-Udager K, Yablon CM. Imaging of ligamentous structures within the knee includes much more than the ACL. J Knee Surg 2018; 31 (02) 130-140
  • 18 Lee JI, Song IS, Jung YB. , et al. Medial collateral ligament injuries of the knee: ultrasonographic findings. J Ultrasound Med 1996; 15 (09) 621-625
  • 19 Warden SJ, Kiss ZS, Malara FA, Ooi AB, Cook JL, Crossley KM. Comparative accuracy of magnetic resonance imaging and ultrasonography in confirming clinically diagnosed patellar tendinopathy. Am J Sports Med 2007; 35 (03) 427-436
  • 20 Fredberg U, Bolvig L. Significance of ultrasonographically detected asymptomatic tendinosis in the patellar and Achilles tendons of elite soccer players: a longitudinal study. Am J Sports Med 2002; 30 (04) 488-491
  • 21 Steinberg N, Stern M, Tenenbaum S, Blankstein A, Zeev A, Siev-Ner I. Ultrasonography and clinical examination of knee injuries in pre- and post- menarche dancers. Res Sports Med 2018; 26 (03) 289-305
  • 22 Westermann RW, Kerr ZY, Wehr P, Amendola A. Increasing lower extremity injury rates across the 2009–2010 to 2014–2015 Seasons of National Collegiate Athletic Association Football: An unintended consequence of the “targeting” rule used to prevent concussions?. Am J Sports Med 2016; 44 (12) 3230-3236