Background: The use of artificial turf in American football continues to grow in popularity, and the effect of these playing surfaces on athletic injuries remains controversial. Knee injuries account for a significant portion of injuries in the National Collegiate Athletic Association (NCAA) football league; however, the effect of artificial surfaces on knee injuries remains ill-defined. Hypothesis: There is no difference in the rate or mechanism of knee ligament and meniscal injuries during NCAA football events on natural grass and artificial turf playing surfaces. Study Design: Descriptive epidemiology study. Methods: The NCAA Injury Surveillance System Men’s Football Injury and Exposure Data Sets for the 2004-2005 through 2013-2014 seasons were analyzed to determine the incidence of anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), medial meniscus, and lateral meniscal tear injuries. Injury rates were calculated per 10,000 athlete exposures, and rate ratios (RRs) were used to compare injury rates during practices and competitions on natural grass and artificial turf in NCAA football as a whole and by competition level (Divisions I, Divisions II and III). Mechanisms of injury were calculated for each injury on natural grass and artificial turf surfaces. Results: A total of 3,009,205 athlete exposures and 2460 knee injuries were reported from 2004 to 2014: 1389 MCL, 522 ACL, 269 lateral meniscal, 164 medial meniscal, and 116 PCL. Athletes experienced all knee injuries at a significantly higher rate when participating in competitions as compared with practices. Athletes participating in competitions on artificial turf experienced PCL injuries at 2.94 times the rate as those playing on grass (RR = 2.94; 95% CI, 1.61-5.68). When stratified by competition level, Division I athletes participating in competitions on artificial turf experienced PCL injuries at 2.99 times the rate as those playing on grass (RR = 2.99; 95% CI, 1.39-6.99), and athletes in lower NCAA divisions (II and III) experienced ACL injuries at 1.63 times the rate (RR = 1.63; 95% CI, 1.10-2.45) and PCL injuries at 3.13 times the rate (RR = 3.13; 95% CI, 1.14-10.69) on artificial turf as compared with grass. There was no statistically significant difference in the rate of MCL, medial meniscal, or lateral meniscal injuries on artificial turf versus grass when stratified by event type or level of NCAA competition. No difference was found in the mechanisms of knee injuries on natural grass and artificial turf. Conclusion: Artificial turf is an important risk factor for specific knee ligament injuries in NCAA football. Injury rates for PCL tears were significantly increased during competitions played on artificial turf as compared with natural grass. Lower NCAA divisions (II and III) also showed higher rates of ACL injuries during competitions on artificial turf versus natural grass.

Introduction Common treatment strategies for proximal humerus fractures include non-surgical treatment, open reduction internal fixation, hemiarthroplasty, and reverse total shoulder arthroplasty. There is currently no consensus regarding the superiority of any one surgical strategy. We used network meta-analysis of randomized controlled trials to determine the most successful treatment for proximal humerus fractures. Methods MEDLINE, EMBASE, Web of Science, and Cochrane Central electronic databases were searched for randomized controlled trials comparing 3- and 4-part proximal humerus fracture treatments. Data extraction included the mean and standard deviation of clinical outcomes (Constant, DASH), adverse events, and additional surgery rates. Standard Mean Difference was used to compare clinical outcome scores, and pooled risk ratios were used to compare adverse events and additional surgeries. Results Eight randomized controlled trials were included for network meta-analysis. Non-surgical treatment was associated with a lower rate of additional surgery and adverse events compared to open reduction internal fixation. Reverse total shoulder arthroplasty resulted in fewer adverse events and a better clinical outcome score than hemiarthroplasty. Non-surgical treatment produced similar clinical scores, adverse event rates, and additional surgery rates to hemiarthroplasty and reverse total shoulder arthroplasty. Conclusion Non-surgical treatment results in fewer complications and additional surgeries compared to open reduction internal fixation. Preliminary data supports reverse total shoulder arthroplasty over hemiarthroplasty, but more evidence is needed to strengthen this conclusion.

Background Gaelic football (GF) and hurling (H) are multi-directional, high velocity, contact sports. Elevated physical demands are thought to cause an increased rate of injury in the lower limb. Objective To examine the incidence and describe lower limb injury in both Gaelic Football and hurling (2008–2011). Design Four-year prospective epidemiological study. Setting 25 Gaelic football teams and 21 hurling teams who compete at inter-county level participated. All data were anonymous. Ethical approval was received by the University College Dublin Human Research Ethics Committee. Participants Adult male Gaelic football (n=841) and hurling (n=696) players were included. Interventions Injury definitions comply with international best practice guidelines and consensus statements. Main outcome measurements Lower Limb injury (LLI) characteristics, exposure information and player demographics were collected via an online platform. Injury rates are expressed as number of injuries per 1000 hours. Severity is expressed as days lost from sport. Percentages were calculated from available totals. Results There were a total of 654 football and 560 hurling LLIs recorded. Match-play LLIs had a higher incidence in both codes (GF:29.8/1000 hrs, H:37.6/1000 hrs) than training LLIs (GF:2.4/1000 hrs, H:2.1/1000 hrs). LLIs caused a median of 16 days timeloss from Gaelic football and 14 days timeloss from hurling. When broken down by body-region, the thigh was the most commonly injured area (GF:42.0%, H:32.1%) followed by knee (GF:16.1%, H:19.3%). Hamstring injury was most prevalent (GF:29.1%; H:23.6%). Hamstring injuries caused a median of 20 days timeloss from football, 21 days lost in hurling. Muscle was the most commonly injured tissue (GF:51.2%, H:46.4%). The most common mechanism of LLI was sprinting (GF:32.1%, H:34.1%). Conclusions This study provides new specific lower limb injury epidemiological information and is the first step towards injury prevention in two sports native to Ireland.

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