| REVIEW ARTICLE |
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| Year : 2020 | Volume
: 10
| Issue : 1 | Page : 10-18 |
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Concussion and lower extremity injury risk following return to activity: A systematic review
Jessica Buttinger1, Jason Mihalik2, Leila Ledbetter3, Mallory Faherty4, Timothy Sell4
1 Duke University, Department of Orthopaedic Surgery, Michael W. Krzyzewski Human Performance Laboratory; Central Michigan University College of Medicine
2 Duke University School of Medicine, Medical Library
3 The University of North Carolina, Department of Exercise and Sport Science, Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center
4 Duke University, Department of Orthopaedic Surgery, Michael W. Krzyzewski Human Performance Laboratory
Correspondence Address:
Ms. Jessica Buttinger
Central Michigan University College of Medicine, 1280 East Campus Dr, Mt Pleasant, MI 48858, USA
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/DORJ.DORJ_16_20
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Aim: The purpose of this systematic review is to present the evidence examining concussion and subsequent lower extremity injury (LEI) risk, and to provide a clinically relevant interpretation of the existing literature for sports medicine clinicians. We hypothesize that there is sufficient high-quality evidence providing an association between concussion and subsequent LEI risk.
Background: In active individuals who have suffered a concussion, even after acute symptoms resolve, the long-term consequences and cognitive deficits that persist remain a pervasive topic of study in sports medicine research. As more studies indicate a risk of secondary injury following a concussion, specifically a risk of LEI, a review of the literature is necessary to bring the latest research into discussion.
Review Results: Of the 459 studies reviewed for eligibility, 10 articles were accepted for systematic review and graded for quality. Overall, eight of the ten studies meeting the inclusion criteria demonstrated an association between concussion and LEI. The risk of LEI following a concussion ranged in studies with odds ratios ranging from 1.72 to 2.48, hazards ratios ranging from 1.47 to 4.07, and the incident rate ratio ranging from 1.97 to 2.02 in athletes who had acquired a concussion versus those who did not.
Conclusion: Taken together, there is enough evidence of sufficient quality to determine that there is an association between concussion and the subsequent risk of acquiring a lower-extremity injury. This systematic review suggests care should be taken in future studies to assess the contributing factors that may predispose an individual to lower extremity injuries following a concussion.
Clinical Significance: Concussions and the subsequent risk of LEI remain a growing concern for sports medicine providers. Our study suggests that there is a need to further investigate the mechanistic processes that may be predisposing an individual to subsequent lower extremity injuries following a concussion, and if this risk can be reduced with appropriate postconcussion care.
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