2015 ISAKOS Biennial Congress Paper #0

The Impact of COVID-19 Pandemic Restrictions on the Incidence of Stress Reactions and Fractures Among Division 1 NCAA Athletes

Brendan Shi, MD UNITED STATES
Varun Sriram, BS, Los Angeles, CA UNITED STATES
Chloe Marie Castaneda, BS, Van Nuys, CA UNITED STATES
Stefani Yamasaki, BS, Torrance, CA UNITED STATES
Shannon Wu, BS, Los Angeles UNITED STATES
Thomas J. Kremen, MD, Los Angeles, CA UNITED STATES
UCLA Department of Orthopaedic Surgery, Los Angeles, CA, UNITED STATES

FDA Status Not Applicable

Summary: Female cross country athletes had lower rates of bony injury in the immediate post-COVID season while male swimmers had higher rates.

Abstract:

Background

The spread of the coronavirus disease 2019 (COVID-19) in February and March of 2020 led to the cancellation of major athletic leagues and sporting events worldwide. In the Pac-12 conference, competitions were cancelled from March to November 2020. While prior studies in professional athletes have shown an increased rate of stress injuries and fractures after long periods of detraining, no studies have explored the impact of such a long period of detraining on college athletes. This study aimed to compare the rate and characteristics of bony injuries among NCAA Division 1 athletes before and after the COVID-19 associated suspension of intercollegiate athletics (CASIA).

Methods

The Pac-12 Sports Injury Research Archive contains all injuries that take place during official NCAA competitions or practices. This database was queried for all in-season, sport-related bony injuries (defined as all stress reactions and fractures) that occurred across all sports from January 2016 to June 2021. The bony injury rate per 1,000 athlete exposure hours (AEH) was calculated and compared between the immediate post-CASIA season and historic rates from pre-CASIA seasons (2016-2019). Injury etiology, timing of onset, severity, rate of procedural intervention, injury mechanism (contact versus non-contact), and likelihood of injury during the 4th quarter of competition (final 25% of competition) was also compared between the pre- and post-CASIA time periods. Results were stratified by gender and sport.

Results

A total of 781 bony injuries across 23 sports were identified. For the majority of sports, there was no significant difference in bony injury incidence rate between the pre- and post-CASIA time periods. However, female cross-country runners, the athlete demographic with the highest historic rate of bony injury pre-CASIA at 0.57 injuries per 1000 AEH, demonstrated a significantly lower bony injury incidence rate in the post-CASIA season (Incidence Rate Ratio (IRR) 0.43, 95% confidence interval 0.21- 0.85). On the other hand, male swimming athletes were found to have a statistically significant increase in bony injury rate from 0.01 to 0.09 injuries per 1000 AEH between the pre- and post-CASIA time periods. Across all sports, the proportion of bony injuries attributed to a repetitive trauma mechanism increased from 14% pre-CASIA to 26% post-CASIA while the proportion of these injuries attributed to a running mechanism decreased from 43% pre-CASIA to 29% post-CASIA (p=0.011).

Conclusion

Across all sports, there was no consistent trend towards increased rates of bony injury in the immediate post-CASIA season. However, female cross country runners demonstrated lower rates of bony injury in the post-CASIA season while male swimmers demonstrated higher rates. Furthermore, bony injuries in the post-CASIA season were more likely to be the result of repetitive trauma and less likely to be from running. These findings demonstrate that the pandemic had a variable impact on athletes from different sports, emphasizing the importance of implementing return to sport protocols that reflect the sport-specific effects of detraining.