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Risk of Athletes With Chiari Malformations Suffering Catastrophic Injuries During Sports Participation Is Low

Meehan, William P. III MD*,†,‡,§; Jordaan, Marc MD; Prabhu, Sanjay P. MD; Carew, Liz BA*,‡; Mannix, Rebekah C. MD, MPH†,§; Proctor, Mark R. MD†,‖

Clinical Journal of Sport Medicine: March 2015 - Volume 25 - Issue 2 - p 133–137
doi: 10.1097/JSM.0000000000000107
Original Research
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Objective: To estimate the risk of athletes with Chiari malformations sustaining a catastrophic injury.

Design: Retrospective, descriptive cohort study.

Participants: All patients diagnosed with Chiari malformation at our institution between June 2008 and November 2011.

Assessment of Risk Factors: Participants were mailed a questionnaire regarding the number of seasons they participated in organized athletics. Magnetic resonance images were reviewed to describe the characteristics of respondent's Chiari malformations.

Main Outcome Measures: Whether or not the patient had sustained an injury resulting in death, coma, or paralysis.

Results: We had a 53% (N = 147) response rate. Respondents were of a mean age of 15 years (SD, 2 years) at the time of diagnosis. The mean length of protrusion of the cerebellar tonsils below the foramen magnum was 11.2 mm (SD, 5.7 mm). Most of the respondents had pointed cerebellar tonsils and some degree of crowding within the foramen magnum. During a total of 1627 athletic seasons played by patients with Chiari malformation, 0 respondents [95% confidence interval (CI), 0.0000-0.0023] sustained an injury resulting in death, coma, or paralysis. Likewise, during 191 collision sport athletic seasons, 0 (95% CI, 0.0000-0.0191) respondents sustained an injury resulting in death, coma, or paralysis.

Conclusions: The risk of athletes with Chiari malformations suffering catastrophic injuries during sports participation is low. This estimate of risk should be considered when making return-to-play decisions. Given the variability of anatomical consideration for patients with Chiari malformations, however, each return-to-play decision must continue to be made on a case-by-case basis, considering all of the available information.

Clinical Relevance: The low risk of athletes with Chiari malformations suffering catastrophic injuries in sports should be considered when making return-to-play decisions.

*Micheli Center for Sports Injury Prevention, Harvard Medical School, Waltham, Massachusetts;

Brain Injury Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts;

Sports Concussion Clinic, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts;

§Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; and

Departments of Radiology; and

Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.

Corresponding Author: William P. Meehan III, MD, Micheli Center for Sports Injury Prevention, 9 Hope St, Suite 100, Waltham, MA 02453-2742 (info@themichelicenter.com).

Supported in part by Micheli Center for Sports Injury Prevention and the National Institutes of Health (T32 HD040128-06A1).

The authors report no conflicts of interest.

Received July 15, 2013

Accepted April 08, 2014

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.