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Jonas Krueckel,1 Dominik Szymski,1 Julia Lenz,1 Julian Fluegel,2 Johannes Weber,1 Leonard Achenbach,3 Rainer Meffert,4 Volker Alt,1 Kai Fehske4,5 1Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany; 2Department of Orthopaedic Surgery, Arcus Clinics Pforzheim, Pforzheim, Germany; 3Department of Orthopaedic Surgery, Koenig Ludwig Haus Wuerzburg, Wuerzburg, Germany; 4Department of Trauma Surgery, University Hosptial Wuerzburg, Wuerzburg, Germany; 5Department of Orthopedic and Trauma Surgery, Johanniter Waldkrankenhaus Bonn, Bonn, GermanyCorrespondence: Kai Fehske, Department of Orthopedic and Trauma Surgery, Johanniter Waldkrankenhaus Bonn, Waldstraße 73, Bonn, 53177, Germany, Email Fehske_k@ukw.de Jonas Krueckel, Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany, Email jonas.krueckel@ukr.dePurpose: While injuries among elite tennis athletes are extensively documented, a notable research gap exists regarding tennis injuries among club-level players. This study examines tennis injuries in German league players, with a particular emphasis on the impact of racquet properties and court surfaces, distinguishing between chronic and acute injuries.Patients and Methods: Retrospectively analyzing data from 600 tennis players over a 1.5-year period, a standardized questionnaire covered anthropometrics, injury characteristics, equipment usage, and court surface conditions.Results: The study identified 1012 tennis-related injuries, averaging 1.7 per player. Acute injuries predominantly affected the lower extremity (56%), with ankle injuries being the most prevalent, and ligaments were the most commonly affected structures (36.4%). Chronic complaints (reported by 364 athletes) focused on the upper extremity (63.2%), primarily tendon injuries (56.8%). Racket properties exhibited no significant impact on chronic upper extremity injuries.Conclusion: This study highlights a high incidence of acute lower extremity injuries, especially ankle ligament injuries, among German league tennis players. It offers crucial insights for devising targeted injury prevention strategies applicable to amateur, semi-professional, and professional tennis players, despite finding no significant link between racquet material and chronic upper extremity injuries.Keywords: tennis, injury, epidemiology, court surface, racquet material, ankle, ligament

Background: To identify the potential role of humeral retrotorsion (HRT) and range of motion (ROM) as a risk factor for shoulder overuse injury in elite youth handball players. The hypothesis was that increased HRT is associated with an increased risk of shoulder overuse injury., Methods: Over 2 seasons, 258 elite youth handball players (52% boys; age:14 ± 0.8 years) were included. Preseason assessment included HRT and glenohumeral internal and external (ER) rotational ROM using ultrasound and a manual goniometer. Sports-specific adaptations between male and female athletes and the dominant and nondominant shoulder were calculated. In addition, players completed standardized questionnaires over the 2018-2019 or 2019-20 season and reported any shoulder overuse symptoms using the Western Ontario Shoulder Index questionnaire., Results: Comparing male and female players showed significantly decreased HRT and decreased internal ROM in the dominant side of male athletes (P ≤ .027). No other difference was found. Significant side-to-side differences between the dominant and nondominant shoulder were found for HRT, internal rotation, and ER, regardless of sex (P < .001). For total range of motion, only female athletes showed a significant increase in the dominant arm (P = .032). The dominant side showed a significantly higher glenohumeral internal rotation deficit in male athletes than in female athletes (10° ± 17° vs 5° ± 10°, P = .011). Adaptations in HRT, ER gain, and total range of motion gain were not significant. Over the course of the 2 seasons, 20 athletes reported shoulder overuse injuries. Although glenohumeral internal rotation deficit was borderline nonsignificant (P = .056), none of the parameters tested were significantly associated with shoulder overuse injuries., Conclusion: Despite significant side-to-side differences and sport-specific adaptations, individual preseason screening of humeral retrotorsion and soft tissue adaptations does not identify elite youth handball athletes at increased risk of shoulder overuse injury., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: To identify mechanisms and patterns of anterior cruciate ligament (ACL) injury in adult women's professional football by means of video match analysis., Methods: ACL match injuries sustained in Germany's first women's league during the 2016-2017 to 2022-2023 seasons were prospectively analysed by three expert raters using a standardised observation form. Epidemiological and injury data, as well as the medical history of ACL tears, were obtained from media reports and the statutory accident insurance for professional athletes., Results: Thirty-seven ACL injuries sustained in official football matches were included in the video analysis, of which 24 (65%) had associated knee injuries, mainly meniscus and collateral ligament injuries. According to the categorised contact mechanisms, 17 (46%) were non-contact injuries, 14 indirect contact injuries (38%) and six direct contact injuries (16%). Of the 17 non-contact injuries, seven (41%) occurred during the first 15 min of the match. Contact mechanisms did not differ between primary and secondary ACL injuries to the same or the contralateral side. Most injuries (80%) of field players occurred during horizontal movements such as sprinting (n=9, 26%), change-of-direction manoeuvres (n=7, 19%), stopping (n=5, 14%) and lunging (n=5, 14%). Four distinct repetitive patterns of ACL match injuries were identified: (1) non-contact 'pressing ACL injury' (n=9), (2) indirect contact 'parallel sprinting and tackling ACL injury' (n=7), (3) direct contact 'knee-to-knee ACL injury' (n=6) and (4) non-contact 'landing ACL injury' (n=4)., Conclusion: Most of the identified patterns of ACL injuries in women's professional football have great potential for prevention., Competing Interests: Competing interests: CK and HB are employed by the VBG., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To compare the standard Yo-Yo intermittent recovery (IR) test and an agility Yo-Yo IR test with a higher number of change-of-direction movements to cardiorespiratory match performance., Methods: The study included 11 professional male handball players (age 24.5 [4.6] y) of a German second-league team. The performance parameters of the players of the seasons 2016-17 to 2018-19 were analyzed. The Yo-Yo IR test was compared to a Yo-Yo IR test with multiple multidirectional changes of direction in response to visual stimuli, which was conducted on a SpeedCourt (Yo-Yo SC IR). Peak oxygen uptake (VO2peak) and maximum heart rate (HRmax) were measured. Between-methods differences of individual athletes were quantified with Bland-Altman plots., Results: HRmax was not statistically different during the Yo-Yo SC IR test compared to the Yo-Yo IR test (181 [10] vs 188 [8] beats·min-1; P = .16). Agreement between the 2 tests was moderate for HRmax and good for heart rates >180 beats·min-1. Mean average VO2peak was 51.7 (3.9) and 50.9 (2.8) mL·min-1·kg-1 for the Yo-Yo SC IR test and the Yo-Yo IR test (P = .693), respectively., Conclusions: A Yo-Yo test with multidirectional changes of direction in response to visual stimuli yielded good agreement with the frequently used linear running tests and can be used to assess players' VO2peak. The HRmax achieved during this test should be used with caution.

Objective: Two-stage exchange with an antibiotic-loaded polymethylmethacrylate (PMMA) spacer is standard treatment for chronic periprosthetic joint infection of the shoulder. We present a safe and simple technique for patient-specific spacer implants., Indication: (Chronic) periprosthetic joint infection of the shoulder., Relative Contraindications: Known allergy against components of PMMA bone cements. Inadequate compliance for two-stage exchange. Patient is unfit to undergo two-stage exchange., Surgical Technique: Hardware removal, histologic and microbiologic samples, and debridement. Preparation of targeted or calculated antibiotic-loaded PMMA. Tailoring of patient-specific spacer. Spacer implantation., Postoperative Management: Rehabilitation protocol. Antibiotic treatment. Reimplantation after successful eradication of infection., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

The aim was to investigate side-to-side and sex differences of anterior and inferior capsule thickness (ACT, ICT) between the throwing and non-throwing shoulder (TS, NTS) in youth elite handball players. 125 youth female and male elite handball players (14.1±0.7yo) were assessed for ACT and ICT by ultrasound . ACT measurement was performed from anterior (3 o'clock) in upright position and for ICT from inferior (6 o'clock) in supine position. Measurements of ICT in the TS of all athletes (1.4±0.2 mm) differed significantly but marginally to those in the NTS (1.3±0.2 mm) ( p = 0.001). Female (1.2±0.2 mm vs. 1.3±0.2 mm; p = 0.007) but not male youth players (1.4±0.2 mm vs. 1.4±0.2 mm, p = n.s.) demonstrated slight differences in ICT in the TS compared with the NTS. Although significant, the thickness in the TS compared to the NTS was within the measurement accuracy of the ultrasonic assessment. No difference in ACT was observed in the TS (1.4±0.3 mm) compared to the NTS (1.4±0.3 mm) for both sexes (n.s.).In conclusion, the anterior and inferior capsule thickness in youth elite handball athletes is not or only marginally different between throwing and non-throwing shoulders.

Introduction: To date, there is no valid single test or battery of tests for informing return-to-play (RTP) decisions following an acute shoulder injury. The purpose of this exploratory study is to evaluate a diagnostic test battery based on a Delphi consensus at the time of unrestricted return to team training after acute shoulder injury., Methods and Analysis: Data for this prospective multicentre cohort study are collected at two measurement time points: when the respective physician clears the patient for RTP (t1) and 12 months after RTP (t2). The study participants are 18-35 years old athletes participating at a professional level in the following team sports: handball, basketball, ice hockey, soccer, volleyball and American football. Maximum comparability will be ensured via uninjured matched pair teammates. To assess the subjective assessment of shoulder functioning and the athlete's readiness to RTP, patient-reported outcome measures (Western Ontario Shoulder Instability Index, Quick-Disabilities of the Arm, Shoulder and Hand, Psychological Readiness of Injured Athlete to Return to Sport and Shoulder Instability-Return to Sport after Injury) will be completed. After a medical check-up with a range of motion and anthropometric measurements as well as clinical tests, the participants will perform a structured warm-up protocol. The functional tests comprise handgrip strength, upper quarter Y-balance test, isometric strength, closed kinetic chain upper extremity stability test, wall hop test, functional throwing performance index and the unilateral seated shot put test and isokinetic tests., Ethics and Dissemination: The results of this study will be disseminated through peer-reviewed publications and scientific presentations at national and international conferences. Ethical approval was obtained through the Institutional Review Board of Martin-Luther-University Halle-Wittenberg (reference number: 2022-016)., Trial Registration Number: DRKS00028265., Competing Interests: Competing interests: HB works for the sponsor of the study as an advisor in the prevention field of sport (prevention department) and IB as an advisor in the field of insurance and benefits (rehabilitation department). Both supervise research projects in their departments and accompany the project participants until successful completion of the study. This is usually defined as successful implementation and transfer of the study results into practice., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: To evaluate the functional outcome of partial reconstruction margin convergence in the treatment of massive, irreparable posterosuperior rotator cuff tear (RCT)., Methods: This retrospective, single-center study included all patients that were operated by means of a partial repair and infraspinatus shift for a massive, posterosuperior cuff tear between 2009 and 2016, either in arthroscopic or mini-open technique. Outcome measures included sex- and age-adapted Constant Score (saCS), Western Ontario Rotator Cuff (WORC) Index, Disabilities of Arm, Shoulder and Hand Scores (DASH), and relative effect per patient (REPP)., Results: Fifty-six shoulders in 54 patients (mean age: 66 ± 7 years) were evaluated at a mean follow-up of 40 ± 9 months. The mean tear size was Bateman 3.1 ± 0.7 and Patte 2.3 ± 0.4. All clinical scores showed improvement. The saCS improved from 64.1 ± 13.4 to 90.4 ± 13.7 (p < 0.0001), the DASH score from 51.8 ± 9.4 to 10.2 ± 13.4 (p < 0.0001) and the WORC index from 47.1% ± 8.6 to 87.9% ± 13.7 (p < 0.0001). The abduction strength of the affected side (1.7 ± 1.6 kg) was not restored to the same level as the contralateral side (5.4 ± 2.7 kg, p < 0.0001)., Conclusion: Partial cuff repair for posterosuperior, massive cuff tears yields good clinical outcome with a low rate of complications and high proportion of good and excellent responders., Level of Evidence: Level IV, therapeutic case series., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: ACL injuries are one of the most severe injuries in football, but medical consequences and performance outcomes after return to competition are only rarely investigated. Aim of this study was to analyse the time of return to competition (RTC) in German professional, semi-professional and amateur football. Also, this investigation highlights the rate of career ending and performance outcome after RTC in different playing levels by the measurement of playing level, performed matches and played minutes., Methods: Database of this investigation is the 'ACL registry in German Football' with prospectively collected injury data. Between 2014 and 2018, four seasons in professional (1st-3rd league), semi-professional (4th-6th league) and amateur leagues (7th league) were analysed regarding the return to competition period and performance parameters. Data were collected for three subsequent seasons after injury and compared with the pre-injury and injury season. Data collection was performed using standardized methods., Results: A total of 607 ACL injuries were registered during the 4-year period with a mean RTC time of 337.1 day (SD: 183). After primary ACL ruptures, the fastest RTC was found in professional football (247.3 days), while in semi-professional (333.5 d; p < 0.0001) and amateur football (376.2 d; p < 0.0001) a prolonged absence was detected. Re-ruptures occurred in 17.8% (n = 108) and showed similar trend with fastest RTC in professionals (289.9 days; p = 0.002). Within the first three seasons after injury, 92 players (36.7%) in semi-professional and 24 (20%) in professionals had to end their career. Keeping the level of play was only possible for 48 (47.5%) of professionals, while only 47 (29.6%) of semi-professionals and 43 (28.1%) of amateurs were able to. Only in professional football, no significant difference could be seen in the played minutes and games after 2 years compared to the pre-injury season., Conclusion: Lower playing levels and re-ruptures are the main factors for a prolonged return to competition after ACL rupture in German football. Significant reduction in playing level and a high rate of career endings were found for all levels of play. However, only professional players were able to regain their playing minutes and games 2 years after injury, while lower classed athletes did not reach the same amount within 3 years., Level of Evidence: Level III., (© 2022. The Author(s).)

Purpose: Anterior cruciate ligament (ACL) injuries are a common severe type of football injury. Injury prevention measures should be adapted to the respective type of sports and be based on sports-specific strategies. A football-specific ACL registry including prospective ACL injury data of both sexes and at different skill levels is lacking in the literature., Methods: In Germany, a prospective 'ACL registry for German Football' was implemented in the 2014-15 football season. Professional football leagues (1 st to 3 rd national league), semi-professional football leagues (4 th until 6 th leagues) and amateur football leagues (7 th league and below) were monitored regarding the incidence of ACL injuries, risk factors, general treatment and rehabilitation. After the registration of an injury, injured players were sent a standardised questionnaire., Results: Overall, 1,206 ACL ruptures were registered in the investigated population of more than 56,000 players, resulting in a prevalence of 2.1%. The highest prevalence was found in men's amateur football (2.7%) as well as in men's and women's professional football (2.1% each)., Conclusion: This football-specific ACL registry provides for the first-time longitudinal data about ACL injury patterns and treatment at all football levels. This report describes the considerations for data collection and presents first epidemiological results of 6 years of ACL injury registration.

A series of new mixed-substituted heteronuclear precursors with preformed Si-Ge bonds has been synthesized via a two-step synthesis protocol. The molecular sources combine convenient handling with sufficient thermal lability to provide access to group IV alloys with low carbon content. Differences in the molecule-material conversion by chemical vapor deposition (CVD) techniques are described and traced back to the molecular design. This study illustrates the possibility of tailoring the physical and chemical properties of single-source precursors for their application in the CVD of Si 1- x Ge x coatings. Moreover, partial crystallization of the Si 1- x Ge x has been achieved by Ga metal-supported CVD growth, which demonstrated the potential of the presented precursor class for the synthesis of crystalline group IV alloys.

Background and Objectives : The aim of the present study was to evaluate the efficacy of a multimodal pain therapy (MPM) regarding the objective parameter muscle strength of segment-dependent lower limb muscle groups before and after such a treatment. Materials and Methods : 52 patients with a history of low back pain and/or leg pain received standardized multimodal pain management. Strength of segment indicating lower limb muscles were assessed for each patient before and after ten days of treatment by handheld dynamometry. Results : Overall strength increased significantly from 23.6 kg ± 6.6 prior to treatment to 25.4 ± 7.3 after treatment, p ≤ 0.001. All muscle groups significantly increased in strength with exception of great toe extensors. Conclusions : Despite lower basic strength values at the beginning of treatment, all investigated muscle groups, except for the great toe extensors, showed a significant increase of overall strength after completion of the multimodal pain management concept. Increased overall strength could help with avoiding further need of medical care by supporting patients' autonomy in daily life activities, as well as maintaining working abilities. Thus, our study is the first to show a significant positive influence on lower limb strength in patients with low back pain after a conservative MPM program.

Purpose: Anterior cruciate ligament (ACL) injuries are a common severe type of football injury at all levels of play. A football-specific ACL registry providing both prospective ACL injury data according to the skill level and risk factors for ACL injury is lacking in the literature., Methods: This study is based on the prospective 'ACL registry in German Football' implemented in the 2014-15 season. Professional (1st-3rd league), semi-professional (4th-6th league) and amateur leagues (7th league) were analysed regarding the incidence and risk factors for ACL injuries. Injuries were registered according to the direct reports of the injured players to the study office and double-checked via media analysis. After injury registration, the players received a standardised questionnaire. Data were analysed from the 2014-15 to the 2018-19 football season., Results: Overall, 958 ACL injuries were registered during the 5-year study period. The incidence of ACL injuries was highest in amateur football (0.074/1000 h football exposure) compared to professional (0.058/1000 h; p < 0.0001) and semi-professional football (0.043/1000 h; p < 0.0001). At all skill levels, match incidence (professional: 0.343; semi-professional: 0.249; amateur: 0.319) was significantly higher than training incidence (professional: 0.015; semi-professional: 0.004; amateur: 0.005). Major risk factors were previous ACL injury (mean: 23.3%), other knee injuries (mean: 19.3%) and move to a higher league (mean: 24.2%)., Conclusion: This sports-specific ACL registry provides detailed information on the incidence and risk factors for ACL injuries in football over five years. Risk factors are skill level, match exposure, move to a higher league and previous knee injury. These factors offer potential starting points for screening at-risk players and applying targeted prevention., Level of Evidence: II., (© 2021. The Author(s).)

Objectives: Handball is associated with a high risk of overuse shoulder injury. This study investigated if an injury prevention programme effectively reduces overuse injury to the throwing shoulder of handball athletes., Methods: 61 men's and women's handball teams (u-19 and senior athletes) were cluster-randomised into an intervention and a control group in the 2019-2020 season. Players of the intervention group regularly carried out an injury prevention programme. Both groups documented overuse shoulder injuries via an online questionnaire every second week. The primary endpoint was the prevalence of overuse injury to the throwing shoulder. Secondary endpoints were the influence of compliance on the primary endpoint and intensity of overuse shoulder symptoms measured by a shortened, handball-specific Western Ontario Shoulder Index (WOSI)., Results: 31 teams (295 players) in the intervention group and 30 teams (284 players) in the control group were included for analyses. The overall questionnaire response rate was 61%. The average prevalence of overuse shoulder injury did not significantly differ between the intervention group (n=109, 38.4% (95% CI 32.9% to 44.2%)) and the control group (n=106, 35.9% (95% CI 30.7% to 41.6%), p=0.542). Compliance with the intervention programme did not significantly affect overuse shoulder injury (p=0.893). Using generalised estimating equations for WOSI, the estimated mean for the intervention group was 44.6 points (95% CI 42.0 to 47.1) and 47.6 points for the control group (95% CI 44.9 to 50.3, p=0.111)., Conclusions: A multicomponent exercise programme using rubber bands and stretching did not significantly reduce the prevalence or symptoms of overuse throwing shoulder injury in handball athletes of both sexes. Randomised controlled study; level of evidence I., Trial Registration Number: ISRCTN99023492., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Introduction: Football is the most popular sport worldwide and results in a high frequency of injuries. So far, mainly injuries in professional football have been investigated, and the literature lacks data regarding detailed injury epidemiology and current prevention data in amateur football tournaments., Materials and Methods: A prospective cohort study investigated an international amateur football tournament, the UEFA Regions' Cup, which took place in 2019 in Germany. Injury epidemiology, current prevention strategies of the teams and the implementation of the UEFA concussion protocol were investigated in detail by means of standardized injury definitions and data samples for football (Fuller et al., Scand J Med Sci Sports 16:83-92, https://doi.org/10.1111/j.1600-0838.2006.00528.x , 2006)., Results: 138 player of 8 teams participated in this study, while 39 players were excluded. Overall injury incidence was 12.5 per 1000 h total football exposure, 43.5 per 1000 h for match exposure. No injuries were registered during training. Injury prevalence was 14.1% per player and 1.1 injuries per match were registered. The lower extremity was predominantly affected by injuries (71.4%) and the majority of injuries (78.6%) were non-severe injury types like contusions (50%) and sprains (18.2%). Two head injuries, one contusion and one skin lesion, were handled by the guidelines of the UEFA concussion protocol. 44.4% of the players indicated at least one previous injury before tournament, 45.3% of them during the last two football seasons before start of the tournament. Injury prevention performance was included in all participating teams during the tournament by warm up or training strategies (100%). During the warm-up program just 5 exercises of the FIFA 11 + program was detected by this investigation in participating teams to be done by more half of the teams. Running exercises were the most frequently performed exercises, while trunk muscle exercises were less represented (14.3%)., Conclusion: This study presents for the first time epidemiological injury and prevention data of the UEFA Regions Cup. Injury incidence was higher compared to injury reports of regular seasons, but lower compared to other amateur football tournaments. Currently used prevention programs revealed trunk muscle exercises as often neglected., (© 2021. The Author(s).)