Objectives. To evaluate the neck strength of school-aged rugby players, and to define the relationship with proxy physical measures with a view to predicting neck strength. Methods. Cross-sectional cohort study involving 382 rugby playing schoolchildren at three Scottish schools (all male, aged between 12 and 18 years). Outcome measures included maximal isometric neck extension, weight, height, grip strength, cervical range of movement and neck circumference. Results. Mean neck extension strength increased with age (p = 0.001), although a wide inter-age range variation was evident, with the result that some of the oldest children presented with the same neck strength as the mean of the youngest group. Grip strength explained the most variation in neck strength (R. 2. = 0.53), while cervical range of movement and neck girth demonstrated no relationship. Multivariable analysis demonstrated the independent effects of age, weight and grip strength, and the resultant model explained 62.1% of the variance in neck strength. This model predicted actual neck strength well for the majority of players, although there was a tendency towards overestimation at the lowest range and underestimation at the highest. Conclusion. A wide variation was evident in neck strength across the range of the schoolchild-playing population, with a surprisingly large number of senior players demonstrating the same mean strength as the 12-year-old mean value. This may suggest that current training regimes address limb strength but not neck strength, which may be significant for future neck injury prevention strategies. Age, weight and grip strength can predict around two thirds of the variation in neck strength, however specific assessment is required if precise data is sought

Objective: Shoulder instability is a common cause of morbidity amongst Professional Rugby Union players. This study explores whether the risk of shoulder dislocation is associated with innate shoulder laxity. Methodology: We performed a pilot study where we validated techniques we used in the study and subsequently gained Ethics committee approval. The study was a controlled study, in which we visited all the Premiership Rugby Clubs in England. We assessed 169 professional rugby players (mean age 25.1 years, range 18–35) with no history of instability in either shoulder and 46 injured players with one shoulder with clinical shoulder instability symptoms (male, mean age 27.5 years, range 20–33) took part in this study. We assessed shoulder laxity by means of clinical evaluation, questionnaires and ultrasound. Anterior, posterior and inferior translation were measured in both shoulders for healthy players and the uninjured shoulder only for injured players. Results: We found there is no significant difference between left (anterior: mean 2.92 mm, SD 1.15; posterior: mean 5.10 mm, SD 1.75; inferior: mean 3.08 mm, SD 1.00) and right (anterior: mean 3.07 mm, SD 1.14; posterior: mean 4.87 mm, SD 1.61; inferior: mean 2.91 mm, SD 0.99) shoulder in healthy players (P > 0.05). The comparison between the healthy shoulders (anterior: mean 3.00 mm, SD 1.15; posterior: mean 4.99 mm, SD 1.68; inferior: mean 3.00 mm, SD 1.00) from healthy players and the normal uninjured shoulder (anterior: mean 4.16 mm, SD 1.70; posterior: mean 6.16 mm, SD 3.04; inferior: mean 3.42 mm, SD 1.18) from injured players identified that players with unstable shoulders have a significantly higher shoulder translation in their normal shoulder than healthy players (P < 0.05). Conclusion: This is the first study looking at laxity and the risk of shoulder dislocations in sportsmen involved in a high contact sport. These results support the hypothesis that rugby players with “lax” shoulders are more likely to sustain a dislocation or subluxation injury to one of these lax shoulders in their sport. We believe pre-season screening and targeted training may play a role in identifying those at risk and may decrease the incidence of dislocations

Fifth metatarsal fractures in sport are known to be associated with acceleration and cross cutting movements when running. It is also established that playing surface has an impact on the ground reaction forces through the foot, increasing the strain through the fifth metatarsal. But what impact does boot design have on these forces? Current thought is that boots that utilise a blade stud design resist sideways slipping of the planted foot more than boots with a rounded stud. This study aims to compare ground reaction forces through the fifth metatarsal in 2 two different designs of rugby boot to assess what impact stud design might have. The forces across the foot were measured using Tekscan in-shoe pressure plates in 24 rugby players. Each player was asked to complete an agility course to measure acceleration, cutting and cross-cutting in the two different designs of rugby boot, reproducing true playing conditions. The boots used were the Canterbury Phoenix Club 8 Stud boot and the Canterbury Speed Club Blade boot. The trial was conducted on an 4G artificial pitch at the Cardiff Arms Park rugby ground. Ethical approval was obtained from Bath University and a research grant was provided by British Orthopaedic Foot and Ankle Society. The blade boot had significantly higher contact pressures than the stud boot on the fifth metatarsal in the combined movements (17.909 ± 10.442 N/cm2 Blade Vs 16.888 ± 9.992 N/cm2 Boot; P < .0125; n= 864 steps in each boot group). The blade boot also produced higher pressure during cross-cutting (32.331 ± 13.568 N/cm2 Vs 27.651 ± 15.194 N/cm2 p < 0.007). Pressures were also higher in both acceleration and cutting, although not significantly so. These results will guide clinicians advising athletes in shoe design, especially those predisposed to or rehabilitating from a fifth metatarsal fracture

The jackaling position within rugby has not been previously described as a mechanism for proximal hamstring injuries. This prospective single surgeon study included 54 professional rugby players (mean age 26 ± 4.8 years) undergoing acute primary surgical repair of complete, proximal hamstring avulsion injuries confirmed on preoperative magnetic resonance imaging. All study patients underwent a standardised postoperative rehabilitation programme. Predefined outcomes were recorded at regular intervals. Mean follow-up time was 17 months (range, 12 months to 24 months) from date of surgery. 51 patients (94.4%) returned to their pre-injury level of sporting activity. Mean time from surgical repair to full sporting activity was 7 months (range, 4 months to 12 months). Zero patients had recurrence of the primary injury. At 1 year after surgery compared to 3 months after surgery, patients had increased mean isometric hamstring muscle strength at 0° (98.4 ± 2.8% vs 88.1% ± 5.4%, p<0.001), 15° (95.9 ± 2.9 vs 88.2 ± 8.1%, p<0.001) and 45° (92.9% ± 4.1% vs 76.8% ± 9.7%, p<0.001), higher mean lower extremity functional scores (77.0 ± 2.3 vs 64.5 ± 4.5, p<0.001), and improved Marx activity rating scores (14.3 ± 1.5 vs 10.7 ± 2.6, p<0.001). Acute surgical repair of proximal hamstring avulsion injuries caused by the contact jackaling position produces high patient satisfaction, high return to preinjury level of sporting activity, with low risk of recurrence at short-term follow-up

Abstract. Objectives. Catastrophic neck injuries in rugby tackling are rare (2 per 100,000 players per year) with 38% of these injuries occurring in the tackle. The aim of this study was to determine the primary mechanism of cervical spine injury during rugby tackling and to highlight the effect of tackling technique on intervertebral joint loads. Methods. In vivo and in vitro experimental data were integrated to generate realistic computer simulations representative of misdirected tackles. MRI images were used to inform the creation of a musculoskeletal model. In vivo kinematics and neck muscle excitations were collected during lab-based staged tackling of the player. Impact forces were collected in vitro using an instrumented anthropometric test device during experimental simulations of rugby collisions. Experimental kinematics and muscle excitations were prescribed to the model and impact forces applied to seven skull locations (three cranial and four lateral). To examine the effects of technique on intervertebral joint loads the model's neck angle was altered in steps of 5° about each rotational axis resulting in a total of 1,623 experimentally informed simulations of misdirected tackles. Results. Neck flexion angles and cranial impact locations had the largest effects on maximal compression, anterior shear and flexion moment loads. During posterior cranial impacts compression forces and flexion moments increased from 1500 to 3200 N and 30 to 60 Nm respectively between neck angles of 30° extension and 30° flexion. This was more evident at the C5-C6 and C6-C7 joints. Anterior shear loads remained stable throughout neck angle ranges however during anterior impacts they were directed posteriorly when the neck was flexed. Conclusions. The combination of estimated joint loads in the lower cervical spine support buckling as the primary injury mechanism of anterior bilateral facet dislocations observed in misdirected rugby tackles and highlights the importance of adopting a correct tackling technique. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

Severe spinal injuries in rugby are rare – but the consequences are considerable. This study presents a series of severe or catastrophic spinal injuries involving under-18 Scottish rugby players since 1992. Demographic and medical data were collected from records at the Queen Elizabeth National Spinal Injuries Unit for Scotland. The players were interviewed personally by the main author, using a questionnaire developed to expose risk factors contributing to injury. All patients were male rugby union players, aged from 14-17. Twelve severe or catastrophic spinal injuries occurred between 1992 and 2009; 10/12 resulted in neurological dysfunction. Six players were forwards and 6 were backs. Three injuries occurred during scrums and 9 injuries resulted from tackles. Five players were injured during league games, 5 during ‘friendly’ games and 1 during a trial game for a regional team. All reported the playing conditions as good and 67% occurred in the second half of the game. The rate of spinal injury was 1 every 3 years from 1992 to 2007. In the last 3 years of the study (2007 to 2010) 7 spinal injuries occurred (including 6 with neurological compromise). 6/12 players thought there was a mismatch between the teams, 3/12 were playing their first game for that team, 2/12 players changed position during the match and 3/12 players were playing above their age group. Overall, one of these four risk factors was present in 10/12 (82%) of cases. 7/12 players felt their injury was preventable. This study demonstrates that the rate of severe spinal injuries in Scottish under-18 rugby had increased to an unacceptable level. Since these data were shared with the Scottish Rugby Union, safety measures have been implemented in an effort to reduce the rate of injuries in youth rugby

Rugby union is the second commonest cause of sporting fracture in the UK. Yet little is known about patient outcome following such fractures. All rugby union fractures sustained during 2007–2008 in the Lothian were prospectively recorded. Patients were contacted by telephone in February 2012 to ascertain their progress in returning to rugby. There were 145 fractures in 143 patients, including 122 upper limb and 25 lower limb fractures. 117 fractures (81%) were followed at mean 50 months (range 44–56 months). 87% returned to rugby post injury, with 85% returning to rugby at the same level or higher. 77% returned by three months and 91% by six months. In upper limb fractures 86% returned by six months and 94% by six months. In lower limb fractures 42% returned by three months and 79% by six months. 32% had ongoing fracture related problems. 9% had impaired rugby ability secondary to fractures. Most patients sustaining a fracture playing rugby union will return to rugby at a similar level. While one third of them will have persisting symptoms post-injury, for the majority this will not impair their rugby ability

Aims: Rugby is a popular sport in Ireland, with over 100,000 players registered with the Irish Rugby Football Union (IRFU) at all levels. We report a 10 year series of spinal injuries presenting to the National Spinal Injuries Unit (NSIU) at the Mater Misericordiae University Hospital. Methods: A large series of spinal injuries in rugby players was isolated utilizing the NSIU database, HIPE and data from the IRFU. An extensive chart review and telephone interview was performed in all cases to determine age, mechanism of injury, possible aetiological factors, anatomic location of injury, American Spinal Injuries Association (ASIA) scores, current level of activity and response to rehabilitation. Results: From 1994 to 2004, 22 rugby players with spinal injuries necessitated admission to the NSIU. Twelve patients (54%) presented with neurology. The average age at time of injury was 21.1 years (range 14 – 44 years) and all patients were male. The average length of hospital stay was 10.1 days (range 1 – 45 days). Twenty patients had cervical spine injuries. The most common mechanism of injury was hyperflexion of the cervical spine, with C5/C6 most commonly injured. Fifteen injuries occurred at adult level, the remainder at schoolboy level. Seventeen (77%) players were injured whilst playing First Team rugby. Eleven (50%) players were injured in the Backs, the remainder in the Forwards. 68% of injuries occurred in the tackle situation and 32% in the scrums, rucks and mauls. Winger, Full Back and Hooker were the playing positions at greatest risk. Nine (41%) patients underwent surgery and 11 (50%) required rehabilitation in the National Rehabilitation Centre, Dun Laoghaire, with an average length of inpatient stay of 9.22 months (range 5 – 14 months). Eight (36%) patients felt that their injury was preventable. Of those patients without neurology, 60% have returned to playing rugby. Conclusion: Rugby as a sporting pastime is not without risk. During the ten year period under review, 8 players suffered permanent disability as a direct result of participation in competitive rugby. Serious spinal injuries continue to occur and recent rule changes have had little effect in reducing their incidence

Aims: Rugby is a popular sport in Ireland, with over 90,000 players registered with the Irish Rugby Football Union (IRFU) at all levels. We report a 10 year series of spinal injuries presenting to the National Spinal Injuries Unit (NSIU) at the Mater Misericordiae University Hospital. Methods: A large series of spinal injuries in rugby players was isolated utilizing the NSIU database, HIPE and data from the IRFU. An extensive chart review and telephone interview was performed in all cases to determine age, mechanism of injury, possible aetiological factors, anatomic location of injury, American Spinal Injuries Association (ASIA) scores, current level of activity and response to rehabilitation. Results: From 1994 to 2004, 22 rugby players with spinal injuries necessitated admission to the NSIU. Twelve patients (54%) presented with neurology. The average age at time of injury was 21.1 years (range 14 – 44 years) and all patients were male. The average length of hospital stay was 10.1 days (range 1 – 45 days). Twenty patients had cervical spine injuries. The most common mechanism of injury was hyperflexion of the cervical spine, with C5/C6 most commonly injured. Fifteen injuries occurred at adult level, the remainder at schoolboy level. Seventeen (77%) players were injured whilst playing First Team rugby. Eleven (50%) players were injured in the Backs, the remainder in the Forwards. 68% of injuries occurred in the tackle situation and 32% in the scrums, rucks and mauls. Winger, Full Back and Hooker were the playing positions at greatest risk. Nine (41%) patients underwent surgery and 11 (50%) required rehabilitation in the National Rehabilitation Centre, Dun Laoghaire, with an average length of inpatient stay of 9.22 months (range 5 – 14 months). Eight (36%) patients felt that their injury was preventable. Of those patients without neurology, 60% have returned to playing rugby. Conclusion: Rugby as a sporting pastime is not without risk. During the ten year period under review, 8 players suffered permanent disability as a direct result of participation in competitive rugby. Serious spinal injuries continue to occur and recent rule changes have had little effect in reducing their incidence

Study Design: Retrospective review. Objectives: Rugby union has recently become a highly-paid professional sport. Players requiring anterior cervical discectomy wish to know the effect this will have on their career. To answer this question, the result of the above procedure in professional rugby players was studied. Methods: A retrospective notes review and telephone interview were conducted on 19 professional rugby players who had a cervical discectomy between 1998 and 2003. Pre and post operative symptoms and numbers returning to rugby after surgery were assessed. Results: Neck pain was eradicated in eight (42%) of the players, nine (47%) achieved partial relief and two were not helped. Brachalgia was eradicated in fifteen (79%) individuals, improved in two (10.5%) and two (10.5%) had no relief. Fourteen (74%) returned to rugby union, the majority at six months post operatively (range – five to 17 months). Thirteen (68.5%) returned to their pre-operative level of rugby; one dropped to a lesser division and five have never played rugby again (three due to physical inability, one due to club reluctance to insure and one because of a separate injury). Two of the players that returned to rugby have subsequently retired because of neck symptoms. They played three and two years post-operatively at first-class level. Conclusion: Return to rugby union after anterior cervical discectomy is both likely and safe and therefore need not be a career ending procedure

Background: Foot injuries represent a small but important proportion of injuries to professional rugby union players. There are no detailed epidemiological studies regarding these injuries. Purpose: The aim of this study was to describe the epidemiology of foot injuries sustained by a cohort of professional rugby union players and identify areas that may be targeted for injury prevention in the future. Study design: Descriptive epidemiological study. Methods: Medical personnel prospectively recorded injuries in professional, premiership rugby union players in England over 4 seasons. Injuries to the foot were identified and the time away from training and playing was reported. Results: A total of 147-foot injuries were sustained resulting in 3,542 days of absence in total. Acute events accounted for 73% of all foot injuries, with chronic, mostly overuse conditions, accounting for 25% (undiagnosed 2%). Chronic conditions led to proportionately more time away from training and playing (p< 0.001). Specifically, stress fractures in the foot accounted for 8% of the total foot injuries but 22% of the absence. Navicular stress fractures had the longest recovery time with the mean return to training and match play of 188 days. Conclusions: In collision sports, such as rugby, injury is inevitable, but clinicians should always be seeking ways to minimise their occurrence and impact. This study revealed significant morbidity associated with chronic and overuse foot injuries in these professional athletes. With greater attention paid to risk factors, some of these injuries, and importantly, recurrent injuries may be avoided

Objective. Shoulder instability is a common cause of morbidity amongst Professional Rugby Union players. This study explores whether the risk of shoulder dislocation is associated with innate shoulder laxity. Methods. A randomised controlled study was completed in which all the Premiership Rugby Clubs in England were visited in 2006. 169 professional rugby players (mean age 25.1 years) with no history of instability in either shoulder were assessed and 46 injured players with one shoulder with a history of Bankart lesion or dislocation (mean age 27.5 years) also took part in this study. Shoulder laxity was measured by dynamic ultrasound. Anterior, posterior and inferior translations were measured in both shoulders for healthy players and the uninjured shoulder only for injured players. Results. No significant difference between the non-dominant (anterior: mean 2.9±1.2mm; posterior: mean 5.1±1.8mm; inferior: mean 3.1±1.0mm) and dominant (anterior: mean 3.1±1.1mm; posterior: mean 4.9±1.6 mm; inferior: mean 2.9±1.0mm) shoulders in healthy players (P>0.05). The comparison between healthy shoulders (anterior: mean 3.0±1.2mm; posterior: mean 5.0±1.7mm; inferior: mean 3.0±1.0mm) from healthy players and the uninjured shoulder (anterior: mean 4.2±1.7mm; posterior: mean 6.2±3.0mm; inferior: mean 3.4±1.2mm) from injured players identified that players with unstable shoulders have a significantly higher shoulder translation in their normal shoulder than healthy players (P<0.05). Conclusion. This is the first study looking at laxity and the risk of shoulder dislocations in sportsmen involved in a high contact sport. These results support the hypothesis that rugby players with ‘lax’ shoulders are more likely to sustain a dislocation or subluxation injury to one of these lax shoulders in their sport even if no symptom is presented

Shoulder instability is a common cause of morbidity amongst Professional Rugby Union players. This study explores whether the risk of shoulder dislocation is associated with innate shoulder laxity. A prospective, randomised controlled study was completed in which all the Premiership Rugby Clubs in England were visited. 169 professional rugby players with no history of instability in either shoulder and 46 players with one shoulder with clinical instability symptoms were assessed. Shoulder laxity was measured by clinical evaluation, questionnaires and ultrasound. Anterior, posterior and inferior translation was measured in both shoulders for healthy players and the uninjured shoulder only for injured players. The results showed there was no significant difference between the left (anterior: mean 2.92 +/− 1.15 mm; posterior: mean 5.10 +/− 1.75 mm; inferior: mean 3.08 +/− 1.00 mm) and right (anterior: mean 3.07 +/− 1.14 mm; posterior: mean 4.87 +/− 1.61 mm; inferior: mean 2.91 +/− 0.99 mm) shoulders in healthy players (P > 0.05). The comparison between healthy shoulders (anterior: mean 3.00 +/− 1.15 mm; posterior: mean 4.99 +/− 1.68 mm; inferior: mean 3.00 +/− 1.00 mm) from healthy players and the uninjured shoulder (anterior: mean 4.16 +/− 1.70 mm; posterior: mean 6.16 +/− 3.04 mm; inferior: mean 3.42 +/− 1.18 mm) from injured players identified that players with unstable shoulders have a significantly higher shoulder translation in their normal shoulder than healthy players (P < 0.05). This is the first study looking at laxity and the risk of shoulder dislocations in sportsmen involved in a high contact sport. These results support the hypothesis that rugby players with “lax” shoulders are more likely to sustain a dislocation or subluxation injury to one of these lax shoulders in their sport

Purpose of the study: ACDF is the cervical surgical technique the most widely used for the treatment of severe discopathy in rugby players. Different techniques have been applied, with no real consensus for the technical procedures or the postoperative rehabilitation. The goal is to normalise the surgical treatment and rehabilitation for elite rugby players who have had a cervical fusion for discopathy with the objective of resuming rugby three months postoperatively. Material and methods: This was a retrospective study including 85 high-level rugby players (professional and semi-professional players) operated on by three surgeons from 2003 to 2008 for one or two levels presenting discal herniation (levels C3 to T1) with cervicobrachial nevralgia unresponsive to conservative treatment. Postoperative function was assessed with the cervical handicap index, a visual analogue scale for pain, consumption of analgesics, and possibility to resume rugby at three months. Flexion-extension radiographs of the cervical spine were obtained. All patients underwent ACDF using a Peek cage filled with autologous iliac bone fixed with a plate or a compressive staple. The patient completed a self-administered satisfaction questionnaire during follow-up. The radiographs and the clinical exam were done by an independent observer (GG). Results: Mean follow-up was 26 months (4–55). Mean operative time was 50 minutes (30–70). Mean hospital stay 2.3 days (1–3). There was no difference between plate and staple fixation. There were no major postoperative complications. Fusion was radiographically achieved in all cases. All patients played competition rugby three months after surgery. At last follow-up, seven players had interrupted rugby playing for personal reasons or for other intercurrent medical conditions. Seventy-eight percent stated their clinical situation had improved and that they were satisfied. Conclusion: The results of this series confirm the pertinence of this method to achieve effective fusion authorising resumption of rugby playing three months postoperatively. Use of a Peek cage filled with autologous bone and stabilised with fixation appears to be necessary to allow rapid functional rehabilitation exercises using a programme of three phases of one month. The normalisation of the treatment for sever cervical discopathies in the high-level rugby player appears to be possible and safe, compared with data in the literature

Purpose of the study: The purpose of this study was to report the clinical and radiographic outcomes a minimum five years after Latarjet-Patte treatment for recurrent traumatic anterior instability of the shoulder in rugby players. It was hypothesised that the Latarjet-Patte procedure fulfils the needs for shoulder stability in rugby players with anterior instability. Material and methods: Thirty-four players (37 shoulders) were included. Mean age was 23.4 years (17–33). A bone lesion of the glenoid was noted in 73% of the shoulders, a humeral defect in 68%. Results: Mean follow-up was 144 months (range 68–237). There was no recurrence (dislocation or subluxation). Apprehension persisted in five patients (14%). Sixty-five percent of the patients resumed playing rugby. Only one patient interrupted his sports activities because of the operated shoulder. The Walch-Duplay and Rowe scores were 86 and 93 points on average. The satisfaction rate was 94%. The block healed in 89% of shoulders (3 fractures, 1 nonunion). Twenty-six shoulders (70%) were free of degenerative disease, 11 shoulders (30%) presented stage 1 lesions. Discussion: In rugby players, anterior instability exhibits characteristic bone lesions of the humerus and glenoid which can be identified as risk factors for recurrent instability. The Latarjet-Patte procedure provides a stable shoulder allowing resumption of rugby player for most patients with no long-term degradation of the shoulder joint. These results are in favour of our strategy to propose the coracoids block systematically for recurrent anterior instability in rugby players

Aim: To determine whether timing of intervention affects neurological outcome after spinal cord injury resulting from rugby cervical facet dislocations. Methods: An observational study on 57 rugby players who were admitted to a Spinal Cord Injuries Unit from 1988 to 2000 with cervical spine facet dislocations. Experienced medical officers, an orthopaedic specialist and physiotherapists determined the admission and discharge Frankel grades (A to E). The time was recorded from the actual injury to successful reduction in hours. The usual method of reduction was by Rapid Incremental Traction on an Awake Patient. Statistical analysis was performed using parametric and non-parametric tests (Mann Whitney). Results: 14 patients were treated within 4 hours of injury and 43 were treated after 4 hours. The median Frankel gain for patients reduced within 4 hours was 5 but only 2 for those reduced after 4 hours (p= 0.0002). Conclusion: Time from injury to intervention does significantly affect neurological outcome in a homogenous group of spinal cord injuries in fit young males as a result of low velocity trauma mechanisms. Spinal cord injuries secondary to cervical facet dislocations in these patients should be regarded as an absolute emergency

Introduction. Catastrophic neck injury is rare in rugby, however the consequences are invariably devastating. Schoolboys have previously been identified as a group at risk. This study came about as a result of a recent increase in admissions of schoolboy rugby players to the National spinal injuries unit in Glasgow. Aim. To audit schoolboy rugby admissions to spinal injury units throughout the United Kingdom and Ireland, in doing so to appraise the current state of data collection. To obtain estimates of playing numbers from the Home unions. Method. Retrospective review of all 12 spinal injury units for records of cases subsequent to 1996. Representatives of each of the four home unions were contacted to confirm cases and establish playing numbers. Results. Records were available from 1996 in Scotland and Ireland and from 2000 in England and Wales. Two units collect prospective data, two had easily retrievable data. In the absence of any register data retrieval was challenging elsewhere. Of the 36 cases 24 would be classified as catastrophic 12 as near misses. The median age for injury was 17. 51% of injuries occurred in the tackle, 35% in the scrum. 92% of scrum injuries involved neurological damage, 61% with complete neurological loss at presentation, 8% with no neurological injury. Tackle injuries were associated with neurological damage in 42%, 26% with complete lesions and no neurological injury in 57%. Estimates for playing numbers (U18 inclusive) approximate to Scotland 19,000, Wales 30,000, Ireland 40,000 and England 1,200,00. Conclusion. •. A persistent number of schoolboys were injured through the study period. •. Recording of serious neck injuries is inconsistent through the United Kingdom and Ireland. •. The numbers injured in Scotland were disproportionate in view of the relative playing populations. •. Whilst less frequent, scrum injuries were more often associated with spinal cord injury

Introduction. Lisfranc joint injuries are increasingly recognised in elite soccer and rugby players. Currently no evidence-based guidelines exist on timeframes for return to training and competition following surgical treatment. This study aimed to see whether return to full competition following surgery for Lisfranc injuries was possible in these groups and to assess times to training, playing and possible related factors. Material/Methods. Over 46-months, a consecutive series of fifteen professional soccer (6) and rugby(9) players in the English Premierships/Championship, was assessed using prospectively collected data. All were isolated injuries, sustained during competitive matches. Each had clinical and radiological evidence of injury and was treated surgically within thirty-one days. A standardised postoperative regime was used. Results. Follow-up was obtained in all fifteen cases. Eight cases were ligamentous injuries and seven were bony. Time from injury to fixation ranged from 10–31 days. One athlete retired following a ligamentous injury. All remaining fourteen returned to training and full competition. Excluding the retired case, mean return to training time was 20.2 weeks and to full competition was 25.6 weeks. No significant difference existed between the mean return to competition time for rugby (27.8 weeks) and soccer(24.7 weeks). A significant difference existed between the mean return to competition time for ligamentous (23.7 weeks) compared to bony(27.6 weeks) injuries(p = 0.012). Three patients suffered deep peroneal nerve sensation loss, two of which fully recovered. Discussion/Conclusion. Return to competitive elite-level soccer and rugby is possible following surgically treated Lisfranc injuries. Return to training can take up to 24 weeks and playing up to 31 weeks, with bony injuries taking longer. To our knowledge this is the largest series of its kind and whilst we recognise it contains small numbers, we feel it provides some guidance on rehabilitative timeframes for those who treat and those who sustain these injuries. Evidence Level: 4

This paper retrospectively reviews the type and outcome of shoulder surgery in 61 professional rugby players (mean age 24.7 years). All competed at provincial level or higher, with 20 competing internationally. Forty-three of the patients played the position of forward, while 33 played back. Most shoulders (41) were on the dominant side. Ten players had multiple procedures and over a seven-year period 76 procedures were performed. The procedures included 16 Latarjets, four arthroscopic stabilisations, four SLAP repairs, four arthroscopic shoulder decompressions, three biceps tenodeses, three HAGL repairs, two revision Latarjets, one posterior Bankart, one pectoralis major repair, one Weaver-Dunn and four combination procedures. All but two players returned to their previous level of competition. The mean time to return to full contact participation was 3.6 months (1 to 12). The time to return was one month for an arthroscopic Mumford and six months for a stabilisation procedure

Over recent years chondrocyte implantation (MACI) has become a recognised procedure. This paper presents the results of two players in the national rugby league competition who play first grade football and have undergone the procedure. Professional sports medical care can be difficult. Demands from players, the public and coaches are beyond our normal requirements as surgeons. Faced with two high-profile players with career ending focal grade 4 chondral lessions and not responding to our normal treatment methods, I performed chondrocyte implantation (MACI) to deal with this. Both players have responded well to treatment and returned to first grade football. The two players in question had focal grade 4 chondral lesions. They had not responded to treatment and had recurrent effusions restricting their ability to play. Player A required a revision acl reconstruction as he was to be away from the game for a year. I treated his chondral lesion with MACI. His effusion settled and he returned to play with no further delays other than those expected from the acl surgery. Encouraged by this result, I performed the second procedure on a very high- profile player who had recurrent pain and effusion and had been treated with arthroscopies with little improvement. Faced with retirement, he opted for the procedure and returned to first grade the following season