PRE-PARTICIPATION SCREENING

Predictability is the information we need as clinicians to decide whether an athlete is safe to return to sport.

General screening programmes are based around questionnaire surveying of the athlete such as those used by DuRant et al (3,4- 6), general orthopaedic testing routines (3,7-10), or general physical function testing (11).

DuRant (3), in a review of general adolescent athletic screening assessments, reported a relationship between risk factors and injury. However, they were unable to predict the incidence of injury from the presence of risk factors ie. athletes with the risk factor did not necessarily develop an injury during the survey period. Gomez et al (11) in their evaluation of the predictive value of the two minute orthopaedic screening examination found that although having good negative predictive values (98.3%), the positive predictive values were poor (40.9%). Therefore while the screening test was good at predicting the athletes that didn’t get injured, it was bad at predicting those who did get injured. Table 2 describes findings from general screening programmes.

It appears therefore that screening for risk factors in general screening programmes are good at predicting the presence or absence of an injury, but are less successful at predicting the potential for an injury to occur.

Studies looking at specific testing procedures appear to fair slight- ly better than general screening programmes at identifying pre- dictability of injury from a risk factor. Screening for specific body parts focused on anatomical alignment, flexibility and strength.

Some factors which did appear to allow prediction of injury include ankle dorsiflexion range of movement for lower limb injury (12), pre-season perceived fatigue (13) and elevated ankle ever- sion to inversion strength ratio for ankle sprains (14). Factors which did not appear to have any predictive qualities included knee ligament laxity (15) and flexibility (12,16). Many of the studies were able to identify a strong relationship between a risk factor and an injury, but were unable to provide evidence of pre- dictability. Table 1 describes findings from specific screening pro- grammes. Unfortunately the evidence for the efficacy of pre-par-

TABLE 1. FINDINGS FROM SPECIFIC SCREENING PROGRAMMES (ADAPTED FROM TAYLOR 1999 (1)) Reference

Pope et al 1998 (12) Tropp et al 1984 (20)

Baumhauer et al 1995 (14)

Study Design Cohort

Case control series Cohort

Part of Body Lower limb Ankle

Ankle

Sommer and Vallentyne 1995 (21) Cross section survey Lower limb Moss et al 1992 (22)

Case control series Dahle et al 1991 (23) Loudon et al 1996 (24) Burkett 1970 (25 Moretz et al 1982 (15) Warren and Jones 1986 (27) Watson 1999 (28) Shambaugh et al 1991 (29) Smith et al 1997 (13) Knee Cross section survey Lower limb Case control series Knee

Case control series Hamstrings Case control series

Knee Hennessy and Watson 1993 (26) Case control series Hamstrings Case control series Cohort Cohort Cohort Foot and ankle Ankle Basketball Ice hockey Subjects

1093 males 127 males

Measurements Ankle dorsiflexion

Stabilometry of ankle, history of previous injury

145 males and females Generalised joint laxity,

anatomical alignment, ankle stability, isokinetic strength

25 males and females Anatomic alignment of the foot 29 females

Knee and foot anatomic 55 males and females 40 females

67 gender unknown 175 gender unknown 34 gender unknown

91 gender unknown 80 males 45 gender unknown 86 males

alignment, isokinetic strength foot alignment in standing hamstring length

Anatomic alignment and

Strength and flexibility General flexibility

Anatomic alignment and

hamstring length range of movement

History, anatomic alignment, Anthropometric variables,

proprioception, flexibility, anatomic alignment anatomic alignment

Anthropometric variables, Anthropometric variables,

anatomic alignment, playing conditions, psychological variables

Steele et al 1986 (30) Watson 1995 (31) Case Control Series Cohort Gymnastics Football 40 females 52 males Flexibility, anatomic alignment Anatomic alignment Visual assessment of anatomic

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