The Knee Ligament Injuries in Wrestlers

Kohei Nakajima, M.D１,2），Teppei Tanaka, M.D１,3） Naoka Fukuda, M.D2），Mika Hangai, M.D 2） Yuki Ara, M.D 2），Yusuke Nishida, M.D2）， Toru Okuwaki, M.D２）

１）Japan Federation ２）Japan Institute of Sports Sciences ３）Tokyo Yamate Medical Center Athletics Training Field (2006)

国立スポーツ科学センター（ＪＩＳＳ）と ナショナルトレーニングセンター（ＮＴＣ） JISS (2001)

Athletes Village(2008) 【Background】

The Clinic in JISS which is adjacent to NTC, has dealt with a large number of top leveled wrestlers in JPN, including those who suffered knee ligament injuries.

Wrestling 911 262 1173 Weightlifting 410 294 704 Athletics 461 231 692 Gymnastics 341 203 544 Football 451 59 510 60 179 239 M F Fencing 91 132 223 Softball 187 187 Swimming 10152 153 Volleyball 89 52 141 0 200 400 600 800 1000 1200

★ Top10 Sports in number of athletes visited to JISS Clinic ( 2001-2008) From our clinical or mat side experience…

The knee injuries are occurring quite often!

【Objective】

To clarify the rate of injuries for each ligament of the knee joint from clinical database of Japanese top wrestlers. 【Materials and Methods】

✓Analyzed 938 (654 males and 284 females) clinical records at JISS clinic where all wrestlers. (2009 ~ 2013 ; 4 years)

✓Reviewed… ① Distribution ② Part of injury ③ Type of injury ④ Category of wrestling 【Results】- ① Distribution

Sex Free Style Greco-Roman Style Total

654 Male 461（21.5） 193（23.9） （22.2） 284 Female 284（21.0） － （21.0） 938 Total 745（21.3） 193（23.9） （21.9）

件数 【Results】- ② Part of Injuries (large classification) n=938

50 Male Female Head or Face 23 182 Upper Extremity 81 171 Spine and Trunk 49 250 Lower Extremity 129 1 Others 2

0 50 100 150 200 250 （n） ★ Incidence of L-Extremity Injuries ：Female=45.4%，Male=38.2% Male Free ：41.6% Male Greco-Roman ：30.1% 【Results】- ② Part of Injuries (detailed) n=938 Head/ Face 73 C-spine 52 Shoulder 97 73 Wrist 28 Hand/Finger 65 Th-Spine 44 L-spine 93 Hip/Pelvis 31 Thigh 20 Knee 244 26.0% Lower Leg 13 Ankle 67 Foot/Toe 35 Others 3 0 50 100 150 200 250 300 （n） 【Results】- ② Part of Injuries (Incidence ratio by style)

Head/ Face Male G C-spine Shoulder Male F Elbow Wrist Female Hand/Finger Th-Spine L-spine Hip/Pelvis Thigh 16,1% 26,9% Knee Lower Leg 31,3% Ankle Foot/Toe Others

0,0% 5,0% 10,0% 15,0% 20,0% 25,0% 30,0% 35,0% 【Results】- ③ Type of Injuries in Knee Joint 102 （n=244） Ligament injuriy 36 49 17 41.8% Meniscus Tendinitis/Peri-T Bursitis/Phremone Arhritis/Pain Bruise Famale Oateoarthritis Male F PLICA/Synovitis Dislocation Male G Osteochondral Muscle/Strain

0 25 50 75 100 125 (n) Breakdown of 【Results】-④ Knee Ligament Injuries （n=102）

MCL 16 27 10 53 52% LCL 13 12 25 24% ACL 5 8 4 17 Female 17% PCL 222 6 Male F 6% Male G PLC* 1 1% PLC* = Posterolateral corner injury 0 20 40 60

★ None of LCL injury in Greco-Roman Style 【Discussion】

Free Style ： Using/ attack on whole limbs freely Greco-Roman Style ： Prohibited using/attack on lower extremity

Knee ligament Inj. ： Free Style ＞ Greco-Roman Style ◆ LCL injury

“Isolated LCL injury is rare, the concept of treatments follows MCL inj.”

Larsen E (Scand J Med Sci Sports. 1999) ・・・Elite footballers Paletta GA (Sports Med. 1994) ・・・Alpine Skiers Bushnell B (Am J Sports Med. 2010) ・・・9 isolated LCL inj. during 10 yrs. periods

Our Study : 25 LCL inj. were detected in only 4yrs. (All injured wrestlers were able to RTP without surgical intervention) Although knee MCL injury is the most frequent injury in , the frequency of Isolated LCL injury is higher than ACL. It seems there is a characteristic knee injury in wrestling as compared to other sports. 【Conclusions】

It seems there is a characteristic knee injury in wrestling as compared to other sports.

But the further investigation is needed… i.e. the location of lesion, course of healing, and prevention program. Thank You For Your Attention….

And see you at Tokyo2020