Download - Decision making in the Contact athlete
![Page 1: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/1.jpg)
Lennard FunkWrightington Upper Limb UnitSalford University
CONTACT ATHLETESDECISION MAKING
![Page 2: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/2.jpg)
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%
![Page 3: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/3.jpg)
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)
![Page 4: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/4.jpg)
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
![Page 5: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/5.jpg)
Recurrent Instability Rates (after arthroscopic stabilisation)
[Cho et al. Arthroscopy 2006]
CONTACT / COLLISION
OVERHEADFLEXIBILITY
29%
7%
![Page 6: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/6.jpg)
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]
![Page 7: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/7.jpg)
• 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]
![Page 8: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/8.jpg)
Recurrence Summary• Higher in contact/collision sport• Higher in young• Higher after surgery for recurrent
dislocations
• Arthroscopic = Open Bankart• Lower after Latarjet procedure
![Page 9: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/9.jpg)
WHY?
![Page 10: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/10.jpg)
PATIENT
![Page 11: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/11.jpg)
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
![Page 12: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/12.jpg)
Injury Reduction Predispostion Model Meeuwisse
![Page 13: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/13.jpg)
PATHOLOGY
![Page 14: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/14.jpg)
Pathology
![Page 15: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/15.jpg)
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
![Page 16: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/16.jpg)
Player Position
• 25 Professional Footballers– 15 Field players– 10 Goalkeepers
Funk & Sargent, 2010
![Page 17: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/17.jpg)
Injury Patterns
![Page 18: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/18.jpg)
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
![Page 19: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/19.jpg)
Investigations• No previous Surgery = MR Arthrogram
• Previous Surgery = CT Arthrogram
![Page 20: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/20.jpg)
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
![Page 21: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/21.jpg)
• An experienced Shoulder Surgeon better
• Can correlate with clinical context• Experience of reviewing Scopes & Scans
![Page 22: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/22.jpg)
Pathology
Major ‘Minor’
• Bony Bankart• ALPSA• Rotator Cuff Tear• HAGL
• Undisplaced Labral Tear• Partial Cuff Tear
![Page 23: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/23.jpg)
Timing of Surgery (Participation)
• Early Surgery:
– Large structural lesions
– Late in Season
– Unable to Return
• Rehab & Return:
– Minor lesions
– Early season
![Page 24: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/24.jpg)
Types of Surgery• Mostly Arthroscopic Direct Repairs• Latarjet for High-Risk/Revision
![Page 25: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/25.jpg)
• 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
![Page 26: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/26.jpg)
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
![Page 27: Decision making in the Contact athlete](https://reader031.vdocuments.mx/reader031/viewer/2022020116/55a517891a28abd07f8b4741/html5/thumbnails/27.jpg)
THANK YOU