Interest in football continues to increase, with ever younger age groups participating at a competitive level. Football academies have sprung up under the umbrella of professional clubs in an attempt to nurture and develop such talent in a safe manner. However, increased participation predisposes the immature skeleton to injury. Over a five-year period we have prospectively collected data concerning all injuries presenting to the medical team at Newcastle United football academy. We identified 685 injuries in our cohort of 210 players with a mean age of 13.5 years (9 to 18). The majority of injuries (542;79%) were to the lower limb. A total of 20 surgical procedures were performed. Contact injuries accounted for 31% (210) of all injuries and non-contact for 69% (475).The peaks of injury occurred in early September and March. The 15- and 16-year-old age group appeared most at risk, independent of hours of participation. Strategies to minimise injury may be applicable in both the academy setting and the wider general community

To describe the treatment and morbidity of lower limb (LL) football fractures in regard to returning to football in a known UK population at all skill levels. All football fractures during 2007–2008 sustained by the Lothian population were prospectively collected with the diagnosis being confirmed by the senior author when patients attended the only adult orthopaedic service in Lothian. Patients living outside the region were excluded from the study. Patients were contacted in August 2010 to ascertain their progress in return to football. There were 424 fractures in 414 patients. 366 fractures (86%) in 357 patients (86%) were followed up with a mean interval of 30 months (range 24–36 months). Of these 32% were sustained in the LL. 88% of LL injuries returned to football compared to 85% of upper limb (UL) fractures (p=0.4). 60% of LL patients were treated as outpatients. 35% were operated on −26% had ORIF and 9% IM Nailing. The most common LL fractures were Ankle 38%, Tibial Diaphysis 14%, 5th Metatarsal 11%, Fibula 9% and Great Toe 7%. Only one of the fractures was an open injury - Gustillo Class 1 2nd Phallanx Foot. Three of the 12 patients who underwent IM nailing required fasciotomy. One patient in the operative cohort developed a significant infection. The mean time for return to football for conservative treatment was 17 weeks (range 3–104 weeks), and for operative treatment 41 weeks (range 10–104 weeks). 91% of patients treated conservatively returned to football, compared to 84% of the operative cohort (p=0.3). 43% of patients had ongoing symptoms from their injury. 9% of the operative cohort required removal of metal work or further operative intervention. 83% of patients returned to the same level of football or higher following injury. Patients under 30 were 1.4 times more likely to return to sport than those over 30 (p<0.05). We have previously demonstrated that football is the most common cause of sporting fracture(1), yet little is known about patient outcome following fractures. LL fractures are less common than UL fractures, and there is no difference in the proportion of patients returning to football following LL fractures and UL fractures. Over half of LL fractures are treated as outpatients and the incidence of open fractures is very low. There is no significant difference between the operative and conservative groups in their return to football. In the over 30 age group, sustaining a fracture may act as a catalyst to quit football. This may explain the higher non-return rate compared to the under 30 age group. 43% of patients perceive that they have ongoing problems with their fracture over 24 months post-injury reflecting the considerable morbidity of football-related fractures

To illustrate the incidence and epidemiology of fractures due to football. All inpatient and outpatient fractures from a prospectively collected database for a defined population in 2000 were retrospectively analysed. There were 396 football fractures, 96% male. Football caused 39% of the 1022 sports fractures in 2000. This represented 5% of the 8151 fractures in total. The incidence was 61/105. 115/105 in males and 5 /105 in females. The average age was 22.9 years; 22.8 in males and 26.6 in females. 77% of fractures were treated as outpatients. The top five fractures representing 84% of the injuries were Radius+Ulna 30%, Phalanx 19%, Tibial+Fibula 18%, Metacarpal 11% and Clavicle 5%. 71% were upper-limb fractures. The busiest two months were October and May 17% and 14% respectively. The quietest two months were February and December at 5%. Although the epidemiology of football injuries will vary amongst different populations, these results can be generalized to similar population bases. Results will be valuable to medical professionals supporting football teams, enabling them to focus their attention on treating the most common injuries, the majority being treated as outpatients. Football is the most common cause of fractures in sport. As participation increases, the incidence of fractures is likely to reflect this. Upper limb fractures account for over 2/3 rd of fractures with radius+ulna fractures accounting for up to a 1/3rd of fractures; the majority can be treated as an outpatient. Therefore medical teams should be familiar with standard treatment regimes, possible impact on players’ futures and time out of sport

The anterior cruciate ligament (ACL) is frequently injured in elite athletes, with females up to eight times more likely to suffer an ACL tear than males. Biomechanical and hormonal factors have been thoroughly investigated; however, there remain unknown factors that need investigation. The mechanism of injury differs between males and females, and anatomical differences contribute significantly to the increased risk in females. Hormonal factors, both endogenous and exogenous, play a role in ACL laxity and may modify the risk of injury. However, data are still limited, and research involving oral contraceptives is potentially associated with methodological and ethical problems. Such characteristics can also influence the outcome after ACL reconstruction, with higher failure rates in females linked to a smaller diameter of the graft, especially in athletes aged < 21 years. The addition of a lateral extra-articular tenodesis can improve the outcomes after ACL reconstruction and reduce the risk of failure, and it should be routinely considered in young elite athletes. Sex-specific environmental differences can also contribute to the increased risk of injury, with more limited access to and availablility of advanced training facilities for female athletes. In addition, football kits are designed for male players, and increased attention should be focused on improving the quality of pitches, as female leagues usually play the day after male leagues. The kit, including boots, the length of studs, and the footballs themselves, should be tailored to the needs and body shapes of female athletes. Specific physiotherapy programmes and training protocols have yielded remarkable results in reducing the risk of injury, and these should be extended to school-age athletes. Finally, psychological factors should not be overlooked, with females’ greater fear of re-injury and lack of confidence in their knee compromising their return to sport after ACL injury. Both intrinsic and extrinsic factors should be recognized and addressed to optimize the training programmes which are designed to prevent injury, and improve our understanding of these injuries. Cite this article: Bone Joint J 2023;105-B(10):1033–1037

Football player's performance during competitive matches greatly depends on fitness and training. The use of GPS (Global Positioning System) has been revolutionary in the monitoring of player intensity during training. The aim of the study was to investigate the difference in training intensity between defenders, midfielders and forwards and if injury sustained was directly related to the intensity of training. GPS (Catapult Minimax GPS 10Hz) was used to collect training data for a professional British football club playing in the Championship, for the year August 2011/April 2012. Each player wore a GPS unit during each training session and the raw data was logged. The GPS calculates the player load which is a measure of intensity of training. It is a summation of instantaneous change of forward, sideway and upward accelerations. Adjustments are made for match days and injuries according to a defined set of rules. A total player load was obtained for each month and at the end of the season. The different injuries sustained throughout the year were logged for each player. This study shows that there is a difference between the intensity of training in different groups of players. The midfielders trained at the highest intensity and, in this group of professional football players, defenders sustained the most injuries GPS technology allows monitoring of player intensity during training. The data obtained will guide training and fitness coaches model training for the individual group of players. This will prepare players for official matches and eventually may help predict and prevent injuries

Objective: To ascertain the epidemiology of ankle injuries in elite youth football. Design: Retrospective analysis of prospectively collected injury data from English Football Association Academies. Setting: Forty-one FA Football Academies, between 1998 and 2006. Participants: For the complete seasons studied, a total of 14776 players were registered from U9 to the U16 age category – a mean of 2463 players per year. All ankle injuries of sufficient severity to miss 48 hours or more training were studied – 2563 injuries in total. Main outcome measurements: The incidence and burden of ankle injuries in this population, and factors associated with injury. Results: There was a mean incidence of one ankle injury per player per year, and a mean of 20 training days and 2 matches were missed per ankle injury. Increased injury rates were seen in older players, in competition and later in each half of match time. Peaks in injury were observed early in the season and after the winter break. In competition, more injuries were associated with a contact situation than in training. Eighty-eight injuries (3.4%) required a lay-off of three months or more and in 18 (0.7%) cases, the player failed to return to training. In total, 52290 training days and 5182 match appearances were lost through ankle injury. The majority of injuries were sprains, but more severe injuries occurred accounted for 3.9% of the total. Conclusions: Ankle injuries are common in young football players, and are often severe, with prolonged loss of training time. This has potential far reaching implications, both on and off the field. Further syudy in this area is suggested

We present an unusual cause of anterior tibial pain in a 24-year-old professional international football player who was found to have a synostosis of the middle-third of the diaphysis of the tibia and fibula. This is a rarely described phenomenon. Conservative treatment is the recommended treatment of choice, but this failed in our patient. Resection produced resolution of symptoms; he remained symptom-free three years later

Introduction: Regular review [. 1. , . 2. ] of cervical injuries occurring in rugby players is an important step toward maximising the safety of the players. It is hoped that the recognition of recurring patterns of injury would lead to appropriate rule modification by the regulatory bodies of the sport. Serious cervical injuries in rugby have been reported to occur by a range of mechanisms, including those involved with scrummaging, tackling, rucking and mauling. Spinal flexion is the commonest mechanism of injury and has been associated with scrum engagement, scrum collapse, rucking or mauling, and mistimed tackling. The second most common mechanism of cervical spinal injury is hyper-extension. This commonly occurs during tackling, particularly the ‘gang tackle’ involving several participants simultaneously, where sudden deceleration of a player’s head may lead to cervical hyperextension, focal spinal stenosis and potential damage to the spinal cord by a “pincer” mechanism. The most commonly reported levels of injury are C5/6 and C4/5 [. 3. ]. Methods: A retrospective review of neck injuries presenting to a major spinal injuries facility and resulting from all codes of football (rugby union, rugby league, soccer, indoor soccer and touch) was conducted and 38 cases identified. Results: Of the 38 patients 14 were injured playing rugby union, 15 rugby league, 3 soccer, 1 indoor soccer, 1 touch football and 4 were playing an unidentified code. 6 players were injured while scrummaging, 5 rugby union and 1 rugby league. 21 people were injured as tacklees, 4 as tacklers and 2 with unspecified involvement in a tackle. 1 person was injured whilst “heading” the ball, and 3 people were injured in a non-contact or unspecified action. At final follow-up, 4 people were found to be quadriplegic (ASIA A), 10 quadriparetic (ASIA B – 0 C −1 and D –9) and 24 recovered completely (ASIA E)

INTRODUCTION: Regular review [. 1. , . 2. ] of cervical injuries occurring in rugby players is an important step toward maximising the safety of the players. It is hoped that the recognition of recurring patterns of injury would lead to appropriate rule modification by the regulatory bodies of the sport. Serious cervical injuries in rugby have been reported to occur by a range of mechanisms, including those involved with scrummaging, tackling, rucking and mauling. Spinal flexion is the commonest mechanism of injury and has been associated with scrum engagement, scrum collapse, rucking or mauling, and mistimed tackling. The second most common mechanism of cervical spinal injury is hyper-extension. This commonly occurs during tackling, particularly the ‘gang tackle’ involving several participants simultaneously, where sudden deceleration of a player’s head may lead to cervical hyperextension, focal spinal stenosis and potential damage to the spinal cord by a “pincer” mechanism. The most commonly reported levels of injury are C5/6 and C4/5 [. 3. ]. METHODS: A retrospective review of neck injuries presenting to a major spinal injuries facility and resulting from all codes of football (rugby union, rugby league, soccer, indoor soccer and touch) was conducted and 38 cases identified. RESULTS: Of the 38 patients, 14 were injured playing rugby union, 15 rugby league, three soccer, one indoor soccer, one touch football and four were playing an unidentified code. Six players were injured while scrummaging, five rugby union and one rugby league. 21 people were injured as tacklees, four as tacklers and two with unspecified involvement in a tackle. One person was injured whilst “heading” the ball, and three people were injured in a non-contact or unspecified action. At final follow-up, four people were found to be quadriplegic (ASIA A), 10 quadriparetic (ASIA B – 0 C –1 and D –9) and 24 recovered completely (ASIA E)

Introduction. This biomechanics investigation evaluated commercially available studded and bladed football boots to determine whether boot type influences potential non-contact ACL injury when football players sidestep cut. Methods. Fifteen professional outfield male football players, without history of lower limb injury, with at least two consecutive injury-free seasons participated. Each undertook three trials of a straight line run and sidestep cuts at 30° and 60° with approach velocity 5.5ms. -1. - 6.0ms. -1. on a FIFA (Fédération Internationale de Football Association) approved artificial football surface. Four pairs of standardised football boots (two bladed and two studded) were investigated. Using 3D inverse dynamics analyses based on an eight camera gait analysis system (120Hz) synchronised with a force platform (960Hz), peak absolute knee internal tibial rotational moments (M. z. ), valgus moments (M. y. ) and anterior joint forces (F. x. ) were determined throughout the stance phase. Values were compared with cadaveric critical limits for ACL injury. A univariate repeated measures ANOVA quantified differences between the variables as a function of cutting angle and boot type. Results. Comparisons between the investigated boots revealed M. z. , M. y. and F. x. were similar for each manoeuvre. Straight line running using studded and bladed boots was associated with M. z. , M. y. and F. x. insufficient for cadaveric injury. Sidestep cutting using studded and bladed boots resulted in M. z. and M. y. significantly greater than during straight line running (p < 0.001), M. z. and F. x. exceeding critical limits and M. y. values which did not. Conclusion. The boot type did not significantly alter potential non-contact ACL injury based on cadaveric critical limits. Sidestep cutting using studded and bladed football boots resulted in M. z. and F. x. sufficient for non-contact ACL injury. Sidestep cutting, when compared to straight line running, may influence potential non-contact ACL injury more than the boot type used by altering knee joint loading to a greater extent

Introduction. Knee injuries are common amongst footballers. The aim of this study was to establish frequency and variation of knee injuries within one English Premier League (EPL) professional football club over two seasons, to assess number of days missed due to injury, and analyse current treatment regimen for each injury type. Method. Data was collected prospectively for injuries suffered by players between 2009 and 2011, spanning two EPL seasons at one EPL club. Demographics were recorded along with various factors influencing injury, including playing surface, pitch condition, dominant side, type of injury, ability to continue playing, and mechanism of injury. Time taken for return to play, and treatment received was recorded. Results. 35 injuries occurred that were severe enough to cause players to miss at least one competitive match. The commonest injury was to the medial collateral ligament (MCL) in 34%. Patella tendon injuries were seen in 29%, other injuries included meniscus tears, ACL ruptures, and osteochondral defects. All grade II MCL Injuries received sclerosant injections. 40% of patella tendon injuries were given plasma-rich protein (PRP) injections, and 30% underwent surgery. The mean recovery time following MCL and patella tendon injuries was 44 days and 77 days respectively. 60% of injuries were sustained during training and 40% were suffered in competitive games. 26% were recurring injuries, recurrent meniscus and patella tendon injuries took twice as long to recover compared to the initial injury. Conclusion. Our findings suggest that MCL and patella tendon injuries are the most common knee injuries amongst professional footballers and that meniscus tears and ligament ruptures are relatively rare in comparison. Injuries appear to occur more frequently during training. A high proportion of injuries in the study received injection therapy in the form of PRP or sclerosant. The study suggests recurrent injuries can prolong recovery two-fold

Introduction. Foot and ankle injuries are a common occurrence amongst all footballers. The aim of this study was to establish the frequency and variation of foot and ankle injuries within one English Premier League (EPL) professional football club over the course of a season and attempt to identify any factors associated with the injuries. Method. Data was collected prospectively for all foot and ankle injuries suffered by first team players over the 2008–09 and 2009–10 EPL season at one EPL club. Each player's demographics were recorded along with various factors concerning or influencing the injury including ground conditions, foot posture index score (FPIS), type of injury, ability to continue playing, recovery time, mechanism of injury and footwear type. Results. The most common injury was 5th metatarsal fracture seen in 33%. Lateral ligament sprain was seen in 28% and syndesmosis injury in 17%. The mean recovery time following 5th metatarsal fractures was 76 days. 67% of all injuries (100% of 5th metatarsal fractures) were sustained while wearing blade footwear, 17% wearing the more traditional studded footwear. Supination was the most common FPIS, present in 43%. 56% of injuries were in the dominant (kicking) side while 50% of injuries were sustained in the tackle. There were no ankle fractures observed. Conclusion. 5th metatarsal fractures are the most common foot & ankle injury amongst professional footballers, ankle fractures are relatively rare in comparison. Injuries occur more frequently with blade footwear, with supination being the most common foot posture at the time of injury

Serious neck injury in rugby football is becoming more common, especially in schoolboys. We report five who presented with spinal cord damage between 1977 and 1983, two in the 1982-83 season. The mechanisms of injury, the treatment, and the outcome are discussed. We suggest measures to reduce the incidence of this most serious injury and draw attention to the appropriate management in the critical phase directly after injury

Introduction. Fifth metatarsal fractures are a common injury suffered by professional footballers. It is frequently reported in the media that such an injury will result in a 6-week absence from play. The purpose of this study was to assess frequency of media reporting of fifth metatarsal fractures, the time that is predicted by the media before the player will return to soccer and the actual time taken for the player to return to play. Methods. Internet search engines identified 40 professional footballers that suffered 49 fifth metatarsal fractures between 2001 and 2011. Information was collected from various media and team websites, match reports, photography and video evidence to provide data regarding the mechanism of injury, playing surface conditions, frequency of fractures per season, fracture treatment, estimated amount of time to be missed due to the injury and time taken to return to play. Results. 49 fractures were identified in the 40 players. 6 players suffered a recurrence of a previous fifth metatarsal fracture. 3 players sustained 5. th. metatarsal fractures in their contralateral foot. There was a trend of increased reporting of fifth metatarsal fractures over the course of the decade. 43% of fractures were sustained without contact with another player, 24% were suffered in a tackle. 77% of fractures were sustained in dry conditions. 90% of fractures were treated surgically. Mean return to play time was 14.6 weeks (range 5 to 34 weeks). The mean estimated absence in the media was 7.8 weeks (range 2 to 16 weeks), median 6 weeks. Conclusions. Fifth metatarsal fractures are being commonly reported in professional footballers with an increasing trend. Most are treated surgically. It appears that the commonly quoted period of 6 weeks before return to play is unrealistic. It should be expected that a player would be unavailable for 3 months

Background & Purpose. The co-ordinated contraction of the kinetic chain is responsible for the dissipation of force. Weakness in the kinetic chain, such as the posterior oblique sling (POS), may increase the demand on additional muscles, such as the hamstrings, to compensate. The lumbar extensors may be particularly vulnerable in the kinetic chain, as they appear difficult to strengthen due to the dominant hip extensors. Therefore, this study aimed to investigate whether participants with a history of hamstring injuries presented with low back pain because of greater deficits in lumbar extensor strength, and impaired co-ordination of the POS. Methods. Twenty male footballers were recruited (n: Injured- 9, Controls- 11). Isolated lumbar extension strength, low back pain, and the contraction time of muscles within the POS during a hip extension test were recorded. Participants were then grouped in either the injury or control group. Conclusion. No differences were observed for lumbar extensor strength (P > 0.05) or the onset of muscular contraction (P > 0.05), though 95% confidence intervals revealed the difference in gluteus maximus onset time (−0.11 – 1.06 s) could be large and may have clinical importance. Descriptive data highlighted the prevalence of back pain was 40% greater in HSI participants. Conflicts of interest. None. Sources of funding. This research was funded by the Wellcome Trust as part of their biomedical vacation award

Introduction: The health benefits of physical exercise are well recognised. In recent years the department of health has been encouraging the UK population to exercise more. We aimed to determine if there was any change in the number and pattern of sport and exercise related injuries attending a city Emergency Department (ED) over the past two decades. Methods: We undertook a prospective comparative study of patients attending an ED over two time periods: Aug 85 – April 86 and Aug 04 – April 05. All identified patients had a standardised proforma inserted into their notes which was prospectively completed by the attending clinician at the time of consultation. Results: We observed a 35% increase in sporting injuries over the 19 year period (1000 injuries out of 37036 new patients vs 1351 out of 37526, p< 0.0001). The total number of new patients attending the ED remained unchanged during this time. Males remain the majority of patients with sports injuries (86%). We noted a change in age distribution with a relative increase in patients under 16 yrs (p< 0.0001), a decrease in 16–24 yrs (p=0.0002) and an increase in patients over 40yrs (p< 0.001). There was a significant reduction in patients presenting out of hours and a significant increase in the delay to presenting at ED with the majority of patients presenting over 4 hours after the injury. Football remains the commonest cause of sports injury accounting for half of all sports injuries, followed by rugby but there has been a relative decline in skiing, martial arts jogging and squash as a cause of injury and a significant increase in injuries due to snowboarding, skateboarding and basketball. Conclusion: There has been an increase in the number of sports injuries attending hospital, which may represent a general increase in sport and exercise participation among our population

In 2008 The Christie was chosen by Manchester United Football Club to form a unique partnership. This funded a specialist Physiotherapist and Occupational Therapist to work exclusively on the Young Oncology Unit, creating the first posts of their kind in the UK. The YOU treats patients between 16–24 years old with a diagnosis of cancer, sarcoma being one of the most common in this age group. All patients attending the YOU now receive a fully comprehensive Physiotherapy and Occupational Therapy service to address their rehabilitation needs. The NICE guidelines (2005) indicate that cancer care for young adults needs to be age specific, age appropriate and undertaken by appropriately trained staff; hence the importance of having specialist therapists on the YOU. The needs of teenagers and young adults with cancer, both physically and psychologically, are more critical than at any other time in life. During their treatment patients will experience stressful events, such as alopecia, weight loss or gain, altered physical appearance, fatigue, nausea and vomiting, absence from education, and reduced contact with peers. The Physiotherapy and Occupational Therapy roles are essential in enabling young adults to adapt to their diagnosis and learn coping strategies to deal with the stressful events they encounter through their cancer experience. During this presentation we will describe the unique role of Physiotherapy and Occupational Therapy with teenagers and young adults, using case studies to illustrate the benefits of having dedicated YOU therapists. We will also share with you the innovative ways in which the Manchester United training facilities have been used for different initiatives that have greatly benefitted and motivated our patients and their families. The partnership between two local organisations, one of the biggest football clubs in the world and a world class Cancer Centre has been a unique and positive liaison

Aims

There is limited information on outcomes of revision ACL reconstruction (rACLR) in soccer (association football) athletes, particularly on return to sport and the rate of additional knee surgery. The purpose of this study was to report return to soccer after rACLR, and to test the hypothesis that patient sex and graft choice are associated with return to play and the likelihood of future knee surgery in soccer players undergoing rACLR.