Date of Award

Spring 2020

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Amanda Seymour

Second Advisor

ToriAnne Yetter

Abstract

Introduction: Both mild traumatic brain injuries (concussions) and anterior cruciate ligament (ACL) tears are among two of the most common, and most career-ending sports medicine injuries. Concussions often result from a blow to the head that can cause headaches, difficulty concentrating, photophobia, and memory loss. Concussion recovery often involved brain rest from athletics, screen exposure, reading, lights, and if severe enough, academics. The ACL is a ligament that is detrimental in stabilization of the knee joint. It connects the femur to the tibia within the joint, and can tear suddenly if it undergoes a quick twisting motion. ACL tears often present with severe pain, inability to apply pressure to the affected limb, swelling, and possibly an audible “popping” noise that can be heard at the time of injury. ACL tears often require surgical repair, and recovery time after the operation can be as long as 9 months. If not career ending, a torn ACL will certainly completely change an individuals athletic aspirations and ability to exercise, even in as early as high school and college. Understanding the probable risk factors of sustaining an ACL tear, like concussions, is incredibly important in proactive medicine, and can help emphasize proper time-off for recovery among athletes. This paper will address the relationship that concussions have on ACL injuries, and the role that return-to-play guidelines after a concussion have in order to improve quality of life, and prevent other injuries among athletes.

Methods: 7 articles were selected after a literature search was completed in September 2018 on PubMed, November 2018 on ClinicalKey, and in November 2018 on Google scholar. These articles were selected based on their relevance to the question, their methods for conducting the study, and their results.

Results: Based on the literature review, there is unsettling evidence that ACL tears may occur more frequently in female athletes who have recently sustained a concussion compared to those that have not. One study showed that athletes who experienced a concussion were 2-3 times more likely to experience a lower extremity injury within the same season. Another study demonstrated that athletes who tore their ACL often had neurocognitive deficits seen on preseason MRI’s and EEGs. Overall, the studies each displayed different points of view as to why concussions could possibly be a risk factor for ACL tears, and stressed the importance of adherence to return-to-play guidelines.

Discussion: Most of the studies provided evidence suggesting that female athletes with concussions had higher rates of ACL tears compared to those who did not. There were a wide variety of study designs that were used, and each of the studies was unique in that there were a number of measured outcomes. These measured outcomes included neurocognitive function, lower extremity injuries, ACL tears, unrecognized concussions, concussion resolution index, jump-landing performance, and reaction times. There were notable limitations in a couple of the studies, including lack of blinding, reporting bias, and small sample sizes.

Conclusion: Concussions as a risk factor for ACL tears among female high school and college athletes should be considered, and research should continue to be done in the subject area. While none of the studies aimed to answer this direct question, all of the data collected in these studies is highly suggestive that a link between the two could exist. Females are two times more likely to experience ACL tears than men, and it is important to discover the probable controllable risk factors for this injury in order to improve quality of life, and allow athletes to continue to play.

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Mild Traumatic Brain Injuries as a Possible Risk Factor for Anterior Cruciate Ligament Tears in Female High School and College Athletes

Introduction: Both mild traumatic brain injuries (concussions) and anterior cruciate ligament (ACL) tears are among two of the most common, and most career-ending sports medicine injuries. Concussions often result from a blow to the head that can cause headaches, difficulty concentrating, photophobia, and memory loss. Concussion recovery often involved brain rest from athletics, screen exposure, reading, lights, and if severe enough, academics. The ACL is a ligament that is detrimental in stabilization of the knee joint. It connects the femur to the tibia within the joint, and can tear suddenly if it undergoes a quick twisting motion. ACL tears often present with severe pain, inability to apply pressure to the affected limb, swelling, and possibly an audible “popping” noise that can be heard at the time of injury. ACL tears often require surgical repair, and recovery time after the operation can be as long as 9 months. If not career ending, a torn ACL will certainly completely change an individuals athletic aspirations and ability to exercise, even in as early as high school and college. Understanding the probable risk factors of sustaining an ACL tear, like concussions, is incredibly important in proactive medicine, and can help emphasize proper time-off for recovery among athletes. This paper will address the relationship that concussions have on ACL injuries, and the role that return-to-play guidelines after a concussion have in order to improve quality of life, and prevent other injuries among athletes.

Methods: 7 articles were selected after a literature search was completed in September 2018 on PubMed, November 2018 on ClinicalKey, and in November 2018 on Google scholar. These articles were selected based on their relevance to the question, their methods for conducting the study, and their results.

Results: Based on the literature review, there is unsettling evidence that ACL tears may occur more frequently in female athletes who have recently sustained a concussion compared to those that have not. One study showed that athletes who experienced a concussion were 2-3 times more likely to experience a lower extremity injury within the same season. Another study demonstrated that athletes who tore their ACL often had neurocognitive deficits seen on preseason MRI’s and EEGs. Overall, the studies each displayed different points of view as to why concussions could possibly be a risk factor for ACL tears, and stressed the importance of adherence to return-to-play guidelines.

Discussion: Most of the studies provided evidence suggesting that female athletes with concussions had higher rates of ACL tears compared to those who did not. There were a wide variety of study designs that were used, and each of the studies was unique in that there were a number of measured outcomes. These measured outcomes included neurocognitive function, lower extremity injuries, ACL tears, unrecognized concussions, concussion resolution index, jump-landing performance, and reaction times. There were notable limitations in a couple of the studies, including lack of blinding, reporting bias, and small sample sizes.

Conclusion: Concussions as a risk factor for ACL tears among female high school and college athletes should be considered, and research should continue to be done in the subject area. While none of the studies aimed to answer this direct question, all of the data collected in these studies is highly suggestive that a link between the two could exist. Females are two times more likely to experience ACL tears than men, and it is important to discover the probable controllable risk factors for this injury in order to improve quality of life, and allow athletes to continue to play.