SLR - April 2023 - Gina Palazzi, DPM PGY-2
Title: Lower Extremity Injury After Return to Sports From ConcussionReference: Jildeh, T. R., Castle, J. P., Buckley, P. J., Abbas, M. J., Hegde, Y., & Okoroha, K. R. (2022). Lower extremity injury after return to sports from concussion: a systematic review. Orthopaedic Journal of Sports Medicine, 10(1), 23259671211068438.
Level of Evidence: III
Scientific Literature Review
Reviewed By: Gina Palazzi, DPM PGY-2
Residency Program: Geisinger, Scranton, PA
Podiatric Relevance: A number of podiatrists work with athletes of all types. This article specifically looked at lower extremity injury after return to sports from concussion. Concussions are relatively frequent amongst athletes at various levels of sport. Concussion doesn’t usually predilect an individual to have lower extremity injury, but this article pulled a wide variety of literature to determine the extent of this phenomenon after concussion.
Methods: In this systematic review, current literature on the topic was pulled from MEDLINE and PubMed with keywords including return to sport, concussion, lower extremity injury, and athlete. Inclusion criteria consisted of articles written in English that reviewed the rate of lower extremity injuries following concussion.
Results: Thirteen studies met the inclusion criteria and 4349 athletes were included. Most athletes were male (88%) and ranged from high school to profession level. Four of the 13 studies noted an elevated risk of lower extremity injury within 90 days of a concussion whereas 6 studies noted increased risk within a year of concussion. The risk of lower extremity injury increased with increased level of competition. The study also noted increase in injury to the lower extremity with increased number of concussions.
Conclusions: This study looked at an interesting concept that as a podiatrist, may seem relatively uncommon, highlighting concussions with lower extremity injury. It portrays another angle in the patient work-up when looking for differential diagnoses, specifically with patients that are athletes. It was noted that lower extremity injury was prevalent at 90 days and up to 1 year of diagnosis of concussion at varying levels of play. This at-risk population may serve to receive post-concussion therapy/modalities catered to lower extremity injury. A limitation of the study was that the “lower extremity injury” was very broad and didn’t adequately define what injuries had been caused following concussion. A follow-up study is needed to determine which specific discrepancies were noted in the lower extremity following concussion.