Injury Rates in Athletics, Health Care Costs & Impact on Performance
Participation in athletics presents an inherent risk for injury. In high school athletics, football has the highest severe injury rate per 1000 athlete exposures, followed by wrestling, girls’ basketball, and girls’ soccer. Among comparable sports, females sustain a higher severe injury rate than boys do, with the knee and ankle accounting for over 41% of them most common severely injured body sites. Decades of research has been devoted to identiﬁcation of intrinsic and extrinsic factors that predispose athletes to injury. Intrinsic factors include lower extremity malalignment, ligament laxity, lower extremity muscle strength/endurance, neuromuscular control, hormonal inﬂuences, intercondylar notch width, and biomechanical technique of sport-speciﬁc performance. Published return to play percentages following an Anterior Cruciate Ligament Reconstruction (ACLR) has traditionally thought to be favorable but recent studies indicate those numbers are much lower than previously thought. The MOON (Multicenter Orthopedic Outcome Network) group recently published results of a multi-site study indicating that 20% of females who have an ACLR will have a second one within 3 years. In a 12 year follow up study published in 2012, investigators found that 79% of those who had an ACLR had osteoarthritis on the involved side. Besides the human toll, there is a huge health care cost associated with. Annually, over 250,000 to 300,000 suffer an ACL injury. With the average cost of $20,000 to $50,000 per injury, the health care cost is well over $5-10B for the initial injury only. This does account for the downstream cost of re-injury (which 27% have) or complications from OA (which 79% develop in 12 years). Although there are some intrinsic factors that cannot be changed, there are many that can be positively influenced with training. Specifically identifying those athletes with pathokinematics (pathological movement patterns or poor mechanics) and implementing a training regime that targets their specific deficits can and will reduce injury rates. Over the last decade, there has been a plethora of studies showing that implementing targeted training programs can result in over 80% reduction in non-contact injuries. If implemented correctly and simply decreasing the incidence by 10% would result in a $500M to $1B health care savings. So prevention and post-operative rehabilitation are essential to restoration of function and ability to return to sport.