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Sport-Related Structural Brain Injury and Return to Play: Systematic Review and Expert Insight.

Scott L Zuckerman1,2, Aaron M Yengo-Kahn1,2, Alan R Tang1

  • 1Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Neurosurgery
|March 11, 2021
PubMed
Summary

Decisions on athletes returning to play (RTP) after sport-related structural brain injury (SRSBI) vary widely. Expert consensus suggests RTP after resolved injury, considering the level of play, but not for persistent hemorrhage.

Keywords:
Collision sportsEpidural hemorrhageFootballReturn to playSportsSubdural hemorrhageTraumatic brain injury

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Area of Science:

  • Neurosurgery
  • Sports Medicine
  • Traumatic Brain Injury

Background:

  • Sport-related structural brain injury (SRSBI) involves intracranial pathology from athletic activity.
  • Current management aligns with non-sport-related brain injuries, but a knowledge gap exists for return-to-play (RTP) protocols.
  • SRSBI necessitates specific guidelines for safe athlete reintegration into sports.

Purpose of the Study:

  • To offer critical insights into operative management and RTP following SRSBI.
  • To achieve this through a focused systematic review of existing literature.
  • To supplement findings with a survey of international expert opinions on SRSBI management and RTP.

Main Methods:

  • Conducted a systematic literature review of SRSBI from 2012 to present, adhering to PRISMA guidelines.
  • Performed a cross-sectional survey distributed to 31 international neurosurgeons specializing in SRSBI.
  • Collected and analyzed data on operative indications and RTP criteria based on injury severity and resolution.

Main Results:

  • The review identified 27 articles, with 9 case reports detailing RTP for 12 athletes.
  • Expert survey revealed varied operative indications for acute, asymptomatic SRSBI (e.g., midline shift, hemorrhage size >10mm).
  • A majority of experts (>75%) permitted RTP to high-contact sports 6-12 months post-injury with resolved hemorrhage, but not with persistent hemorrhage.

Conclusions:

  • Return-to-play decisions for athletes with SRSBI demonstrate significant heterogeneity among specialists.
  • Aggregated expert opinions provide valuable guidance for managing SRSBI and determining RTP.
  • The level of athletic competition was identified as a significant factor influencing RTP decisions.