Collegiate Concussion Prevention Rules May Increase Rates of Post-Traumatic OA

HealthDay News – Lower‐extremity injuries sustained during American football games have been associated with increased rates of post‐traumatic osteoarthritis1 (OA).To assess whether lower extremity injury rates were increasing due to new concussion rule changes for college football players, Robert Westermann, MD, and colleagues from the University if Iowa queried in‐game injuries from the NCAA Injury Surveillance System, and presented the results at the American Orthopaedic Society for Sports Medicine’s Specialty Day, on March 5 in Orlando, Fla.2

The new study included information collected by athletic trainers and physicians between 2009 and 2014. Lower extremity injuries included those affecting the leg, knee, ankle, and foot. Concussion risk information was also gathered.

During the study time frame, 2,400 leg, joint, or foot injuries serious enough to cause a time-out in play occurred. About a third involved injuries to the knee (33.6 percent), while slightly less than that involved the ankle (28.6 percent). Nearly 60 percent were the result of player-to-player contact. 

Concussion risk remained relatively stable over the study period, the researchers found. However, leg, joint, and foot injuries rose from 9.45 per 1,000 athletic exposures during the 2009-10 seasons (before the new rules were implemented) to 12.63 per 1,000 by the 2013-14 season.

“Of course concussions sustained in football can be devastating,” Dr Westermann told HealthDay. “But so can lower extremity injuries, which are the leading cause of disability among National Football League retirees. So, it’s important to protect the whole athlete.”

Summary and Clinical Applicability

Post-traumatic lower extremity OA is a major cause of morbidity to football players later in life. The authors write, “Since the initiation of these rule changes… injuries to the lower extremity have increased. In order to comply with avoiding head‐to‐head contact, players may be targeting the lower extremities. This is concerning as lower extremity injuries and post‐traumatic osteoarthritis are common causes of disability in retired American Football players.”


1. Ratzlaff CR, Liang MH. New developments in osteoarthritis. Prevention of injury-related knee osteoarthritis: opportunities for the primary and secondary prevention of knee osteoarthritis. Arthritis Res Ther. 2010;12(4):215.

2.Westermann RW, Wehr P, Amendola A. Unintended Consequences of Concussion Prevention in NCAA Football. Paper 15, abstract presented at American Orthopaedic Society for Sports Medicine’s Specialty Day, Orlando Florida.