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Background: At the Second International Conference on Concussion in Sport, concussion was classified as ''simple'' or "complex" based largely on duration of clinical features. The purpose of the classification system was to assist clinicians in identifying higher grades of injury severity and guide injury management. The aim of the current paper is to review the validity and clinical usefulness of the simple versus complex classification system. Study design: Qualitative review of the literature on concussion in sport, with a focus on time course of clinical recovery and prognostic factors. Intervention: Pubmed, Medline and Sport Discus databases were reviewed. Fifty journal articles were included in the review. Results: Prospective studies support the recovery of symptoms, balance deficits and cognitive impairment in the majority of concussed athletes within 10 days of injury. However, clinical factors that predict higher grades of injury severity or poor outcome following concussion remain unclear. At present, concussion severity can only be accurately determined in retrospect after all clinical features have resolved. Conclusion: It is recommended that concussion in sport be considered as a single entity. Clinical factors that have demonstrated to be associated with longer duration of symptoms (for example, post-traumatic amnesia) or poor outcome (for example, repetitive head injury) may serve as ''modifying'' factors to assist the treating practitioner in identifying potential for higher grades of injury severity or adverse outcomes. [ABSTRACT FROM AUTHOR]

Background: Concussion is a common neurological injury occurring during contact sport. Current guidelines recommend that no athlete should return to play while symptomatic or displaying cognitive dysfunction. This study compared post-concussion cognitive function in recently concussed athletes who were symptomatic/asymptomatic at the time of assessment with that of non-injured (control) athletes. Methods: Prospective study of 615 male Australian Rules footballers. Before the season, all participants (while healthy) completed a battery of baseline computerised (CogSport) and paper and pencil cognitive tasks. Sixty one injured athletes (symptomatic=25 and asymptomatic=36) were reassessed within 11 days of being concussed; 84 controls were also reassessed. The serial cognitive function of the three groups was compared using analysis of variance. Results: The performance of the symptomatic group declined at the post-concussion assessment on computerised tests of simple, choice, and complex reaction times compared with the asymptomatic and control groups. The magnitude of changes was large according to conventional statistical criteria. On paper and pencil tests, the symptomatic group displayed no change at reassessment, whereas large improvements were seen in the other two groups. Conclusion: Injured athletes experiencing symptoms of concussion displayed impaired motor function and attention, although their learning and memory were preserved. These athletes displayed no change in performance on paper and pencil tests in contrast with the improvement observed in asymptomatic and non-injured athletes. Athletes experiencing symptoms of concussion should be withheld from training and competition until both symptoms and cognitive dysfunction have resolved. [ABSTRACT FROM AUTHOR]

This paper reviews the pros and cons of the traditional paper and pencil and the newer computerised neuropsychological tests in the management of sports concussion. The differences between diagnosing concussion on the field and neuropsychological assessment at follow up and decision making with regard to return to play are described. The authors also discuss the issues involved in interpreting the results of neuropsychological testing (comparison with population norms versus player's own baseline test results) and potential problems of such testing in football. Finally, suggested recommendations for neuropsychological testing in football are given. [ABSTRACT FROM AUTHOR]

Background-"Paper and pencil" neuro-psychological tests play an important role in the management of sports related concussions. They provide objective information on the athlete's cognitive function and thus facilitate decisions on safe return to sport. It has been proposed that computerised cognitive tests have many advantages over such conventional tests, but their role in this domain is yet to be established. Objectives-To measure cognitive impairment after concussion in a case series of concussed Australian Rules footballers, using both computerised and paper and pencil neuropsychological tests. To investigate the role of computerised cognitive tests in the assessment and follow up of sports related concussions. Methods-Baseline measures on the Digit Symbol Substitution Test (DSST), Trail Making Test-Part B (TMT), and a simple reaction time (SRT) test from a computerised cognitive test battery (CogState) were obtained in 240 players. Tests were repeated in players who had sustained a concussive injury. A group of non-injured players were used as matched controls. Results-Six concussions were observed over a period of nine weeks. At the follow up, DSST and TMT scores did not significantly differ from baseline scores in both control and concussed groups. However, analysis of the SRT data showed an increase in response variability and latency after concussion in the injured athletes. This was in contrast with a decrease in response variability and no change in latency on follow up of the control players (p < 0.02). conclusion-Increased variability in response time may be an important cognitive deficit after concussion. This has implications for consistency of an athlete's performance after injury, as well as for tests used in clinical assessment and follow up of head injuries. [ABSTRACT FROM AUTHOR]

BACKGROUND: At the Second International Conference on Concussion in Sport, concussion was classified as 'simple' or 'complex' based largely on duration of clinical features. The purpose of the classification system was to assist clinicians in identifying higher grades of injury severity and guide injury management. The aim of the current paper is to review the validity and clinical usefulness of the simple versus complex classification system. STUDY DESIGN: Qualitative review of the literature on concussion in sport, with a focus on time course of clinical recovery and prognostic factors. INTERVENTION: Pubmed, Medline and Sport Discus databases were reviewed. Fifty journal articles were included in the review. RESULTS: Prospective studies support the recovery of symptoms, balance deficits and cognitive impairment in the majority of concussed athletes within 10 days of injury. However, clinical factors that predict higher grades of injury severity or poor outcome following concussion remain unclear. At present, concussion severity can only be accurately determined in retrospect after all clinical features have resolved. CONCLUSION: It is recommended that concussion in sport be considered as a single entity. Clinical factors that have demonstrated to be associated with longer duration of symptoms (for example, post-traumatic amnesia) or poor outcome (for example, repetitive head injury) may serve as 'modifying' factors to assist the treating practitioner in identifying potential for higher grades of injury severity or adverse outcomes. [ABSTRACT FROM AUTHOR]

Background Arthroscopy is increasingly used to improve pain and function in athletes with hip joint pathology. Surgical techniques have evolved to utilise arthroscopic femoral osteoplasty to address potential morphological contributors to pathology. Purpose Investigate pain and function outcomes following hip arthroscopy with and without femoral osteoplasty in individuals with intra-articular hip pathology. Study design Systematic review. Methods A comprehensive search strategy identified studies that evaluated the outcome over at least 3 months following arthroscopy for intra-articular hip pathology, using patient-reported outcomes of pain and/or function. Methodological quality was evaluated (Downs and Black scale), and effect sizes calculated when sufficient data were available. Results Twenty-nine studies of moderate methodological quality were included. Of 16 studies investigating arthroscopy alone, two studies showed large effects (3.12-5.46) at 1-2 years. Pain reduction and functional improvement (median 47%) were consistently reported by the remaining 14 studies up to 10 years postsurgery. Of 15 studies investigating arthroscopy with osteoplasty, nine papers showed mostly large effects (0.78-2.93) over 6-28 months. Adverse events were minimal (7% of participants, 12 studies, predominantly transient neuropraxia (83%)). Conclusion Current evidence indicates that hip arthroscopy can significantly reduce pain and improve function in patients with intra-articular hip pathology. While benefits of arthroscopy alone can persist up to 10 years postsurgery, effects of osteoplasty beyond 3 years need to be established. Future studies should investigate rehabilitation in this population, and the impact of surgery on development of osteoarthritis. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of a preseason physical training programme that taught landing and falling skills in improving landing skills technique and preventing injury in junior elite Australian football players. Methods: 723 male players who participated in an under 18 elite competition were studied prospectively in a non-randomised controlled trial over two consecutive football seasons. There were 114 players in the intervention group and 609 control players. The eight session intervention programme taught players six landing, falling, and recovery skills, which were considered fundamental for safe landing in Australian football. Landing skills taught in these sessions were rated for competence by independent and blinded assessors at baseline and mid-season. Results: Evaluation of landing skills found no significant differences between the groups at baseline. Evaluation after the intervention revealed overall improvement in landing skills, but significantly greater improvement in the intervention group (z = -7.92, p = 0.001). Players in the intervention group were significantly less likely (relative rate 0.72, 95% confidence interval 0.52 to 0.98) to sustain an injury during the season than the control group. In particular, the time to sustaining a landing injury was significantly less for the intervention group (relative rate 0.40, 95% confidence interval 0.17 to 0.92) compared with the control group. Conclusions: Landing and falling ability can be taught to junior elite Australian football players. Players in the intervention group were protected against injury, particularly injuries related to landing and falls. [ABSTRACT FROM AUTHOR]

Objective: To compare the long term outcomes of the two treatment options for navicular stress fractures: non-weightbearing cast immobilisation and surgical fixation. Design: Retrospective case study. Participants: Subjects aged 18 years and older who had been treated for a navicular stress fracture more than two years previously. Main outcome measures: Questionnaire based analogue pain score and function score; tenderness on palpation; abnormality detected on computed tomography (CT). Results: In all, 32 fractures in 26 subjects were investigated. No significant differences were found between surgical and conservative management for current pain (p = 0.984), current function (p = 0.1 70), or abnormality on CT (p = 0.173). However, surgically treated patients more often remained tender over the "N spot" (p=O.OO5), even after returning to competition for two years or more. Conclusions: Surgical fixation of navicular stress fractures appears to be as effective as conservative management over the longer term. However, there remains a small but measurable degree of pain and loss of function over this period. The value of using "N spot" tenderness as the sole clinical predictor of treatment success requires further investigation, as some patients remained tender despite successful completion of treatment and return to competition. [ABSTRACT FROM AUTHOR]

The association between self reported history of concussion and current neurocognitive status is controversial. Some football studies suggest that athletes with a history of concussion display cognitive impairment relative to athletes with no history of concussion, but other studies have not been able to reproduce such findings. This study shows that there is no relation between the number of previous self reported episodes of concussion and current cognitive state, directly contradicting the findings of previous research. [ABSTRACT FROM AUTHOR]