A framework for recording recurrences, reinjuries, and exacerbations in injury surveillance

A previous injury can increase the risk of sustaining a similar injury by up to an order of magnitude. To understand the role of previous injury as a risk factor, it is necessary to consider, among other issues, the clinical status of the first (index) injury at the time of the subsequent (recurrent) injury: currently, the inconsistent use of descriptive terms for recurrent injuries makes this extremely difficult. Although recent consensus statements on injury definitions based on return-to-play criteria have provided a consistent methodology for recording and reporting index and recurrent injuries, these statements do not differentiate between the types of recurrent injuries that can occur. This paper presents a recording and reporting framework that subcategorizes recurrent injuries into reinjuries and exacerbations on the basis of whether a player was fully recovered from the preceding index injury, with the state of fully recovered determined by medical opinion. A reinjury is a repeat episode of a fully recovered index injury and an exacerbation is a worsening in the state of a nonrecovered index injury. With this more detailed framework, researchers will be able to investigate risk factors for reinjuries and exacerbations separately, and they will be able to investigate how well players have been rehabilitated before returning to full training and match play.