Regarding myth 1, my data presented at this year’s American Academy of Orthopaedic Surgeons Annual Meeting, which is slated for publication, showed that among a consecutive cohort of high school athletes who presented to a single health care system between September 2013 and December 2016, a preponderance of concussions can be attributed to football. Nearly 30% of concussions were attributed to football injuries, the most commonly concussed sport among high school athletes. The next highest was hockey at about 21% and soccer at 17%.
Although data evaluating varsity high school football players from 1956 to 1970 did not show an increased risk of developing neurodegenerative diseases compared to athletes in other varsity sports, I question the applicability to contemporary football. The game has changed, and it has become significantly more physical. Moreover, it is difficult to control for athlete game exposure in a cohort of high school athletes. When investigating retired NFL players, who undoubtedly had a high-level of exposure to football throughout their careers, it is evident that the rate of neurodegenerative diseases is significantly higher among football players.
Regarding myth 2, my recent data show that among high school athletes who sustained multiple concussions and received multiple rounds of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) score as their primary neuropsychological exam, the subdomains of mean visual motor speed and reaction time showed predictable decreases with each recurrent concussion. This echoes previous findings in the literature that multiple concussions cause a decrease in cognitive function among athletes.
Moreover, in my study, patients were only permitted to return to sport after completing the six-step pathway recommended by the CDC. We found a significant increase in return to sport timing in those with a previous history of concussion. This suggests that prior concussions may have lingering effects and that incomplete recovery may cause additive cortical and subcortical pathogenesis in a dose-response manner. Furthermore, this may have long-term implications and could potentially contribute to chronic traumatic encephalopathy
My comments above also apply to myth 3.
Concerning myth 4 about the frequency of high school football injuries being at an all-time high, this is likely true. Injury detection, injury surveillance and adherence to protocol have all increased significantly in recent years. In 2000, Kevin M. Guskiewicz, PhD, ATC, and colleagues conducted an epidemiological study of high school and college football players who sustained concussions. The study demonstrated that an alarming 30.8% of concussed players returned to competition on the same day, and 20% of athletes never left the game. A study by Margot Putukian, MD, FACSM, and colleagues, suggested that high school athletes take about 30 days to return to sport after a concussion. This finding was likely due to a more contemporary approach to young athletes that emphasizes more careful and conservative treatment. My study found similar findings, as high school athletes required approximately 30 days of recovery before return to sport after a concussion.
Guskiewicz KM, et al. Am J Sports Med. 2000;doi:10.1177/03635465000280050401.
Jildeh TR, et al. Abstract 306. Presented at: AAOS Annual Meeting; March 12-16, 2019. Las Vegas.
Putukian M, et al. Br J Sports Med. 2009;doi:10.1136/bjsm.2009.058230
Toufic R. Jildeh, MD
Henry Ford Health System
Disclosures: Jildeh reports no relevant financial disclosures.