The Impact of Prior Upper Extremity Surgery on Orthopaedic Injury and Surgery in Collegiate Athletes

OBJECTIVES: Upper extremity injuries are common in youth, collegiate, and professional athletics, and may require operative management. The influence of a prior upper extremity surgery on subsequent athletic participation, injury, and surgery in college is not well understood. The purpose of this study was to investigate the impact of prior upper extremity surgery in Division I collegiate athletes on participation, injury rates, and surgery rates in college. METHODS: Division I athletes who began participation in collegiate athletics from 2003 - 2009 were retrospectively identified. These athletes represented 21 sports teams at a single institution. Athletes with prior upper extremity orthopaedic surgery, including shoulder, elbow, and wrist/hand surgery, were identified through preparticipation evaluation forms. Sport, seasons played, injuries sustained during college, days missed, and college orthopaedic surgeries and diagnostic imaging were collected through sports archives, medical records, and the Sports Injury Monitoring System (SIMS) and compared to athletes with no prior history of upper extremity surgery. Subgroup analysis was performed for athletes with a history of shoulder, elbow, and wrist/hand surgeries. RESULTS: Between 2003 and 2009, 1,145 athletes completed pre-participation evaluation forms. In total, 77 athletes (6.7%) had a history of one or more upper extremity surgeries prior to collegiate athletics. History of upper extremity surgery was most common in incoming men's water polo (15.0%), baseball (14.9%), and football (12.6%) athletes. Athletes with a prior upper extremity surgery had a higher rate of upper extremity injury in college compared to controls (Hazard Ratio = 4.127, p <0.01), and missed more days for upper extremity injuries per season (16.5 days vs. 6.7 days, p = 0.03). Athletes with a prior shoulder surgery (n=20) also had a higher rate of upper extremity injury in college compared to controls (Hazard Ratio= 15,083, p=0.02). They missed more total athletic days per season (77.5 days vs. 29.8 days, p <0.01), had more MRIs (0.96 vs. 0.40, p <0.01), and underwent more total orthopaedic surgeries per season in college compared to controls (0.23 vs. 0.08, p <0.01). Career length was not significantly different between athletes with a history of upper extremity surgery and control athletes. CONCLUSION: Collegiate athletes who had an upper extremity surgery prior to college had increased rates of upper extremity injury and missed more days due to upper extremity injury in college. Those with prior shoulder surgery additionally had more diagnostic imaging and orthopaedic surgery in college. Careful consideration of these athletes, particularly those who have had prior shoulder surgery, may be beneficial in the recruitment process. Moreover, athletes and athletic trainers should be made aware of the increased injury rates in this population, so that appropriate counseling and rehabilitation may be provided.