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Competing Interests: Competing interests: IRM reports the following disclosures: Arthrex: paid consultant. Bone and Joint Research: editorial or governing board. Journal of Bone and Joint Surgery British: editorial or governing board. Stryker: paid consultant. AG reports the following disclosures: American Orthopaedic Society for Sports Medicine: board or committee member. Arthroscopy: editorial or governing board, Infographics Editor. Ossur: paid presenter or speaker. Smith & Nephew: paid consultant; paid presenter or speaker. JC reports the following disclosures: American Orthopaedic Society for Sports Medicine: board or committee member. Arthrex: paid consultant. Arthroscopy Association of North America: board or committee member. CONMED Linvatec: paid consultant. International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine: board or committee member. Ossur: paid consultant. Smith & Nephew: paid consultant. GM reports the following disclosures: Smith & Nephew: paid consultant. IBSA: paid consultant. International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine: board or committee member. Arthroscopy: editorial board. JBJS: editorial Board. RFL reports the following disclosures: American Journal of Sports Medicine: editorial or governing board. American Orthopaedic Society for Sports Medicine: board or committee member. Arthrex: IP royalties. International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine: board or committee member. Journal of Experimental Orthopaedics: editorial or governing board. Knee Surgery, Sports Traumatology, Arthroscopy: editorial or governing board. Ossur: IP royalties; paid consultant; research support. Smith & Nephew: IP royalties; paid consultant; research support. Journal of Knee Surgery: editorial or governing board. Orthopaedic techniques in Sports Medicine: editorial or governing board. JJI reports the following disclosures: receives funding as PI from Department of Defense Congressionally Directed Medical Research Programme Peer-Reviewed Orthopaedic Research Programme for the Surgical Timing and Rehabilitation (STaR) Trial for Multiple Ligament Knee Injuries (MLKIs): A Multicenter Integrated Clinical Trial (W81XWH-17-2-0073) and serves as President, Board of Directors for Movement Science Media/Journal of Orthopaedic and Sports Physical Therapy. GM reports the following disclosures: Smith & Nephew, IBSA: Consultant. ISAKOS: committee memberJBJS and arthroscopy: Editorial. BoardSmith & Nephew: fellowship funding. GFH III reports the following disclosures: Arthrex: consultant. MS reports the following disclosures: Arthrex: consultant and Royalties Stryker, USA Hockey Foundation: Research Funding. MEK reports the following disclosures: AANA: Research committee. AOSSM: Enduring Education committee Arthrex, Smith and Nephew: education funds. PM reports the following disclosures: Arthrex and Conmed: Consultant Arthrex, Conmed, Zimmer Biomet, Smith and Nephew, Ossur: research and fellowship support. KC reports the following disclosures: BJSM: Senior advisor. BL reports the following disclosures: Arthrex: Consultant and Royalties. JKS and KSSTA: editorial board. MM reports the following disclosures: Smith and Nephew: paid speaker. KT reports the following disclosure: deputy editor: BJSM. TGM reports the following disclosures: Arthrex: Speaker, Consultant. CORR: editorial board. EV reports the following disclosures: associate editor: BJSM Editor-in-Chief: BMJ Open SEM. AJK reports the following disclosures: Arthrex: Consultant, IP royalties, JRF Orthopaedics, Vericel, Responsive Arthroscopy: Consulting fees. DJO: Grants Musculoskeletal Transplant Foundation: Board of Trustees. RCS reports the following disclosures: Arthrex: education editorial board: AJSM and JBJSJPS reports the following disclosures: Thieme: Publishing Royalties DePuy: consulting fees/teaching courses Arthrex: consulting fees/teaching courses AO NA: research support, teaching and travel support. AO Foundation—teaching/travel support. Journal of Knee Surgery—Editor-In-Chief. CE reports the following disclosures: Canadian Institutes of Health Research, Canada Foundation for Innovation, Canada Research Chairs Programme and National Football League Play Smart Play Safe Programme: peer-reviewed research support. Associate Editor: BJSM. External Advisory Board: HitIQ Chairperson: Sport injury Prevention Research Centre, an IOC Research Centre for Prevention of Injury and Protection of Athlete Health. HG reports the following disclosures: associate editor: BJSM, JOSPT. RGM reports the following disclosures: mend nutrition. Royalties from Springer and Demos for books. JLC reports the following disclosures: AANA: research support. AO trauma: research support. Arthrex: IP royalties; paid consultant; research support. Bioventus: paid consultant. Boehringer Ingelheim: paid consultant. Collagen Matrix: paid consultant; research support. GE healthcare: research support Journal of Knee Surgery: editorial or governing board. Midwest Transplant Network: board or committee member. Musculoskeletal Transplant Foundation: board or committee member; IP royalties; research support. National Institutes of Health (NIAMS & NICHD): research support. OREF: research support. Orthopaedic Trauma Association: research support. PCORI: research support. Regenosine: research support. SITES Medical: research support Thieme: publishing royalties, financial or material support. Trupanion: paid consultant. VM reports the following disclosures: Smith & Nephew, Newclip: Consultant Ostesys: Shareholder Arthrex, Smith & Nephew: educational grants. ISAKOS: board or committee member. KSSTA: Deputy Editor-In-Chief. MTH reports the following disclosures: Knee Surgery Sports Traumatology Arthroscopy (KSSTA): Deputy Editor-In-Chief. APKASS journal, MLT journal, Arthroskopie, Das Knie (DKG), board or committee member. European Knee Associates (EKA): Past Chairman. ESSKA Milan 2020 and 2021: Scientific Chairman. ISAKOS: Arthroplasty Committee, ESSKA: Cartilage Committee. German Knee Society: board or committee member. Personalized Arthroplasty Society (PAS): 2nd vice president DepuySynthes, Smith & Nephew, Symbios, Medacta: Consultant DepuySynthes, Finceramica, Symbios, Mathys, Arthrex, SIWF, Deutsche Arthrose-Hilfe, Bangerter-Rhyner-Stiftung: research grants. NM, HP, SPE, KDS, CJW, FRN, MT, DCJvR, EK, DBW, MDM, GCF, CH, LE, RS and NP report no competing interests.

The aim of the present study was to evaluate the characteristics of match injury in male beach soccer players. Video recordings of all official beach soccer tournaments in which the European national male beach soccer teams participated from 2018 to 2021 were analysed by two sports medicine specialists retrospectively. Regarding each injury, data including the mechanism, location of the injury, whether the injury led to time-loss, and the relationship of the injury to the bicycle kick (BK), etc. were documented. A total of 632 injuries were documented, corresponding to 234.9 injuries/1000 player hours. Video footage was available for 580 injuries. Whilst 79.8% of medical attention injuries occurred due to opponent contact, 19.5% of time-loss injuries occurred due to non-contact, and 12.2% of indirect opponent contact ( p  < 0.01). The most common location of the BK related injury was the head/neck (68.7%), whereas most common location of the BK unrelated injury was the lower extremity (54.1%) ( p  < 0.01). The findings demonstrated that beach soccer injury incidence was quite high; the most common injury location was head/neck and head/neck injuries were associated with BK. In light of these results, some rule regulations, particularly those associated with BK, and the use of protective equipment should be considered to prevent these injuries.

Purpose: This study aimed to identify, through a 28-week follow-up, the association between pain and engagement in different sports among adolescents., Methods: In total, 63 adolescents reported the occurrence of pain, which was tracked weekly. Participants were categorized into 2 groups based on their sports participation: "swimming group" and "other sports group." Researchers directly measured the time spent in different intensities during sports participation for 1 week using a heart rate monitor. For the covariates, body mass, body fatness, and whole-body lean soft tissue were assessed using a dual-energy X-ray absorptiometry scanner. Kaplan-Meier plots and risk of pain were calculated for the absence of pain during the follow-up., Results: The association between the sport type and pain occurrence remained significant even after adjusting the models for potential confounders, showing that swimmers had an increased risk of reporting pain in the neck (HR = 3.33; 95% CI, 1.53-7.25), shoulders (HR = 2.21; 95% CI, 1.17-4.21), and trunk (HR = 5.60; 95% CI, 2.28-13.70)., Conclusion: The association between the sport type and pain occurrence is evident even when controlling for confounding factors.

Objectives: To assess the clinical competence of sports medicine physicians to recognise and report harassment and abuse in sports, and to identify barriers to reporting and the need for safeguarding education., Methods: We implemented a cross-sectional cohort study design recruiting through social media and international sports medicine networks in 2023. The survey captured participant perceptions related to the harmfulness of harassment and abuse. The survey incorporated the reasoned action approach as a theoretical framework to design survey questions to identify attitudes and self-efficacy to detect and report suspicions of harassment and abuse and to identify barriers to reporting., Results: Sports medicine physicians (n=406) from 115 countries completed the survey. The situations of harassment and abuse presented in the survey were described by sports medicine physicians as having occurred in the 12 months before participating in the survey. Despite recognising the situations as harmful, sports medicine physicians were somewhat uncomfortable being vigilant for the signs and symptoms and reporting suspicions and disclosures of harassment and abuse (M=2.13, SD=0.67). In addition, just over one-quarter (n = 101, 26.9%) was unaware of where to report harassment and abuse, and over half did not know (n = 114, 28.1%), or were uncertain (n = 95, 23.4%) of who the safeguarding officer was in their sports organisation. Participants identified many barriers to reporting harassment and abuse, including concerns regarding confidentiality, misdiagnosis, fear of reprisals, time constraints and lack of knowledge. Over half felt insufficiently trained (n = 223, 57.6%), and most respondents (n=324, 84.6%) desired more education in the field., Conclusions: Educational programmes to better recognise and report harassment and abuse in sports are needed for sports medicine trainees and practising clinicians. An international safeguarding code for sports medicine physicians should be developed., Competing Interests: Competing interests: MM is a deputy editor of the BJSM and a member of the BJSM IPHP Editorial Board. EV is an associate editor of the BJSM, an associate editor of the BJSM IPHP and editor in chief of BMJ Open Sports and Exercise Medicine. JTF is the training, prevention and rehabilitation section editor for Current Sports Medicine Reports. AM is an associate editor of the BJSM., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Need for Innovation: Teaching and learning approaches can support medical students in developing the research skills necessary to be adept consumers of scientific research. Despite various influencing factors, existing literature on effective strategies in undergraduate medical education remains limited., Goal of Innovation: Using a spiraled curriculum, we created and evaluated a longitudinal course to enhance medical students' research abilities., Steps Taken for Development and Implementation of Innovation: During a recent curriculum renewal at one medical school, a three-year longitudinal course on the principles of research was developed and implemented. The innovation of this course includes the sequential nature and deliberate redundancy of curriculum content, how new knowledge is linked to prior learning, and the progressive level of difficulty in knowledge application and skill development., Evaluation of Innovation: The authors analysed faculty members' and students' satisfaction and their perceptions of each session of the course using program evaluation data collected between 2019 and 2021. Both faculty members and students recognized the benefits of revisiting concepts and highlighted learning outcomes like improved synthesis of information, explaining findings to patients, and enhanced critical thinking., Critical Reflection: The adoption of a spiraled curriculum in undergraduate medical education offers a systematic approach for developing students' research skills. The positive reception of this innovation underscores its potential to help future health professionals form a professional identity as adept researchers. However, its implications demand careful consideration and ongoing evaluation to ensure that the desired outcomes are sustained., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Aims: We examined the prevalence and incidence of mental health symptoms (MHS) in active professional male footballers over a 12-month period and investigated if MHS was associated with severe injuries or surgeries., Participants and Methods: Football Players Worldwide (FIFPRO) affiliated national unions invited active professional male football players to participate in the study. MHS was operationalised in symptoms of anxiety, disordered eating, depression, distress, sleep disturbance, alcohol misuse and drug misuse, all being assessed with validated questionnaires., Results: Of the 101 participants enrolled, the prevalence of distress was 53% and MHS was between 6% for drug misuse and 48% for alcohol misuse. The incidence of distress was 29% and MHS ranged from 1% for anxiety to 11% for sleep disturbance. At baseline, players suffering from injury/surgery were more likely to report depression (OR 1.35; 95%CI 1.10-1.70) and disordered eating (OR 1.22; 95%CI 1.02-1.47). At follow-up, players who suffered injury or surgery were inclined to report distress (OR 2.15; 95%CI 1.26-4.31) and drug misuse (OR 2.05; 95%CI 1.01-4.04)., Conclusion: There seems to be a greater prevalence of MHS in active professional male footballers than in the global population and other sports. After severe injury/surgery, the risk of developing MHS is increased, confirming that healthcare professionals should be aware of the mental health of injured players., (© 2024. The Author(s).)

Para athletes present a broad range of sports-related injuries and illnesses, frequently encountering barriers when accessing healthcare services. The periodic health evaluation (PHE) is a valuable tool for continuously monitoring athletes' health, screening for health conditions, assisting in the surveillance of health problems by establishing baseline information and identifying barriers to athlete's performance. This position statement aims to guide sports healthcare providers in the PHE for Para athletes across key impairment categories: intellectual, musculoskeletal, neurological and vision. A panel of 15 international experts, including epidemiologists, physiotherapists, optometrists and physicians with expertise in Para athlete health, convened via videoconferences to discuss the position statement's purpose, methods and themes. They formed working groups to address clinical, cardiorespiratory, neuromusculoskeletal, nutritional status, mental and sleep health, concussion and female Para athlete health assessment considerations. The PHE's effectiveness lies in its comprehensive approach. Health history review can provide insights into factors impacting Para athlete health, inform physical assessments and help healthcare providers understand each athlete's needs. During the PHE, considerations should encompass the specific requirements of the sport modality and the impairment itself. These evaluations can help mitigate the common tendency of Para athletes to under-report health issues. They also enable early interventions tailored to the athlete's health history. Moreover, the PHE serves as an opportunity to educate Para athletes on preventive strategies that can be integrated into their training routines, enhancing their performance and overall health. This position statement can potentially enhance clinical translation into practice and improve the healthcare quality for Para athletes., Competing Interests: None declared., (Copyright © 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.)

Competing Interests: Competing interests: MM is a deputy editor of the BJSM and a member of the BJSM IPHP Editorial Board. EV is an associate editor of the BJSM, an associate editor of the BJSM IPHP and editor in chief of BMJ Open Sports and Exercise Medicine. JTF is the training, prevention and rehabilitation section editor for Current Sports Medicine Reports. AM is an associate editor of the BJSM,

Women's football has grown in popularity, competitiveness and professionalism, increasing the demands placed on players and their injury risk. This study aimed to identify differences in the match workload and international travel between injured and non-injured professional women's footballers. The study was conducted as an observational, retrospective, case-control study over two football seasons (2021/2022 and 2022/2023) in four top-tier European women's football leagues. Fifty-eight professional women football players (81 injuries) formed the injury group and were matched with 81 elite women football players (162 non-injuries), from the same league, to form the control group. For each injury, cumulative match workload (minutes played, appearances, days between matches, rest) and international travel (distances, time, time zones crossed) were calculated over a 28-day period preceding the injury, for both the injured players and matched controls. The injured group had a higher number of instances of less than 5 days between matches compared to the controls (p = 0.03, effect size = 0.3, small). The anterior cruciate ligament injury group made more appearances (p = 0.09, effect size = 0.8, moderate), had more instances of less than 5 days between matches (p = 0.09, effect size = 0.8, moderate) and had less rest time (p = 0.12, effect size = 0.8, moderate) than the control group. No meaningful differences were observed between the hamstring injury group and the control group. These findings underscore the importance of careful consideration when developing match fixture schedules in elite women's football, particularly concerning the number of matches scheduled in a short period. Strategies to increase rest and recovery are recommended to safeguard players against injuries., (© 2024 The Author(s). European Journal of Sport Science published by Wiley‐VCH GmbH on behalf of European College of Sport Science.)

Background: Individuals with anterior cruciate ligament (ACL) injury often exhibit visual cognitive deficits during tasks that require neuromuscular control. In this paper, we present evidence of increased visual reliance after ACL injury during a range of clinically applicable cognitive-motor tasks. This information is essential to strengthen the scientific rationale for therapeutic interventions that target maladaptive neuroplasticity and may translate to improved return-to-sport (RTS) outcomes following ACL injury., Objectives: The objectives of this study are (1) to determine if visual reliance is present during common rehabilitation-based assessments after ACL deficiency (ACL-D) or ACL reconstruction (ACL-R), (2) to describe how visual reliance is assessed during such tasks, and (3) to provide information to help clinicians and patients understand the clinical relevance of cognitive load in the assessment and intervention of visual reliance., Design: Scoping review., Literature Search: We searched MEDLINE, EMBASE, CINAHL, SCOPUS, and PEDro databases., Study Selection Criteria: Only primary studies published in English were included without time limitations., Data Synthesis: Qualitative analysis of the included studies was performed., Results: We synthesized the results of 23 studies. A total of 7 studies (31%) included patients with ACL-D, 15 studies (65%) included patients with ACL-R, and 1 study (4%) included patients with ACL-D and ACL-R. Evaluation of tasks, task evaluation setting, visual conditions, outcome measures, and presence of increased visual reliance were identified. Most studies investigating patients with ACL-D, contrary to those with ACL-R, exhibited worse postural stability during eyes-closed conditions than uninjured controls. Complete visual obstruction (i.e., eyes closed or blindfolded) was the most frequently reported method to disrupt vision (52%). The addition of a visual-cognitive challenge resulted in significantly worse postural stability in patients with ACL-R compared with controls., Conclusions: Visual reliance was most commonly assessed during single leg stance with complete visual obstruction. The majority of studies on patients with ACL-D indicate that they exhibit poorer postural stability in eyes-closed conditions when compared with uninjured controls, which suggests increased visual reliance. There is less evidence of visual reliance in patients who have undergone ACL-R compared with those with ACL-D. Adding a visual-cognitive load was found to be more effective in inducing postural stability deficits in individuals who have undergone ACL-R., Level of Evidence: IV. The protocol was a priori registered on Open Science Framework ( https://osf.io/p4j95/ )., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Rugby is a physically demanding sport with a high injury rate. Professional male rugby players have a notably greater risk of sustaining injuries that require hospitalisation or surgery than male athletes from non-contact sports. Retired elite male rugby players experience physical and mental health conditions as well as varying levels of pain, negatively impacting their quality of life. Retired rugby players could use medication or substances as a coping mechanism to deal with chronic pain and a lower quality of life. However, research is scarce on how retired rugby players manage pain and how this affects their quality of life., Objectives: This study aimed to understand joint pain and impairment, mental and physical quality of life, and pain medication use in retired professional male rugby players., Methods: A cross-sectional study was conducted using a questionnaire completed by retired professional male rugby players. Joint pain and impairment were explored through three questions, health-related quality of life was assessed through the PROMIS-GH, and medication use was explored through 12 questions., Results: Retired rugby players (N=142) reported higher scores than matched controls (N=49) for joint pain and impairment, including significantly higher scores for joint impairments for activities of daily living ( p =0.047). The global mental health scores of retired rugby players were significantly lower compared to matched controls (p=0.043) and the global physical health scores were also lower in retired rugby players. Most retired rugby players reported not using prescription pain medication (75%) or over-the-counter pain medication (56%)., Conclusion: Professional rugby careers have a considerable impact on the joint health and overall well-being of retired players, resulting in unique challenges. The findings of this study emphasise the need for specific after-career support for challenges faced by retired rugby players., Competing Interests: Conflict of interest and source of funding: The authors declare no conflict of interest and no source of funding.

Background and Objective: Competitive alpine skiing, snowboarding and freestyle skiing, all different in nature and risks, are known for their high injury and illness burden. Testing measures and training methods may be considered for athletes' preparation to support performance enhancement while safeguarding their health. We explored the perspectives and perceptions of competitive alpine skiing, snowboarding and freestyle skiing stakeholders regarding testing and training practices in their competitive snow sports., Methods: We conducted an exploratory qualitative study based on grounded theory principles through 13 semi-structured interviews about testing and training practices with athletes, on-snow and off-snow coaches, managers and healthcare providers from different national teams. The interviews were inductively analysed through a constant comparative data analysis., Results: Participants described winning as the end goal of testing and training practices, which requires athletes to perform in their best condition. To do so, they mentioned two main targets: performance enhancement and health protection. Participants acknowledged health as a premise to perform optimally, considering testing and monitoring approaches, goal setting, and training to support and protect athlete performance. This continuous cyclic process is driven by communication and shared decision making among all stakeholders, using testing and monitoring outputs to inform goal setting, training (e.g. on-snow and off-snow) and injury prevention. Such an approach helps athletes achieve their goal of winning while being fit and healthy throughout their short-term and long-term athletic career development., Conclusions: The ultimate goal of testing measures and training methods in such competitive snow sports is winning. Performance enhancement and health protection act as pillars in systematic, tailored and flexible processes to guarantee athletes' best preparation to perform. Moreover, athletes' assessments, goal setting, monitoring tools, open communication and shared decision making strongly guide this cyclic process., (© 2024. The Author(s).)

Multiligament knee injuries (MLKIs) represent a broad spectrum of pathology with potentially devastating consequences. Currently, disagreement in the terminology, diagnosis and treatment of these injuries limits clinical care and research. This study aimed to develop consensus on the nomenclature, diagnosis, treatment and rehabilitation strategies for patients with MLKI, while identifying important research priorities for further study. An international consensus process was conducted using validated Delphi methodology in line with British Journal of Sports Medicine guidelines. A multidisciplinary panel of 39 members from 14 countries, completed 3 rounds of online surveys exploring aspects of nomenclature, diagnosis, treatment, rehabilitation and future research priorities. Levels of agreement (LoA) with each statement were rated anonymously on a 5-point Likert scale, with experts encouraged to suggest modifications or additional statements. LoA for consensus in the final round were defined 'a priori' if >75% of respondents agreed and fewer than 10% disagreed, and dissenting viewpoints were recorded and discussed. After three Delphi rounds, 50 items (92.6%) reached consensus. Key statements that reached consensus within nomenclature included a clear definition for MLKI (LoA 97.4%) and the need for an updated MLKI classification system that classifies injury mechanism, extent of non-ligamentous structures injured and the presence or absence of dislocation. Within diagnosis, consensus was reached that there should be a low threshold for assessment with CT angiography for MLKI within a high-energy context and for certain injury patterns including bicruciate and PLC injuries (LoA 89.7%). The value of stress radiography or intraoperative fluoroscopy also reached consensus (LoA 89.7%). Within treatment, it was generally agreed that existing literature generally favours operative management of MLKI, particularly for young patients (LoA 100%), and that single-stage surgery should be performed whenever possible (LoA 92.3%). This consensus statement will facilitate clinical communication in MLKI, the care of these patients and future research within MLKI., Competing Interests: ompeting interests: IRM reports the following disclosures: Arthrex: paid consultant; Bone and Joint Research: editorial or governing board; Journal of Bone and Joint Surgery—British: editorial or governing board; Stryker: paid consultant. AG reports the following disclosures: American Orthopaedic Society for Sports Medicine: board or committee member; Arthroscopy: editorial or governing board, Infographics Editor; Ossur: paid presenter or speaker; Smith & Nephew: paid consultant; paid presenter or speaker. JC reports the following disclosures: American Orthopaedic Society for Sports Medicine: board or committee member; Arthrex: paid consultant; Arthroscopy Association of North America: board or committee member; Conmed Linvatec: paid consultant; International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine: board or committee member; Ossur: paid consultant; Smith & Nephew: paid consultant. GM reports the following disclosures: Smith & Nephew: paid consultant; IBSA: paid consultant; International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine: board or committee member; Arthroscopy: editorial board; JBJS: editorial board. RFLP reports the following disclosures: American Journal of Sports Medicine: editorial or governing board; American Orthopaedic Society for Sports Medicine: board or committee member; Arthrex: IP royalties; International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine: board or committee member; Journal of Experimental Orthopaedics: editorial or governing board; Knee Surgery, Sports Traumatology, Arthroscopy: editorial or governing board; Ossur: IP royalties, paid consultant, research support; Smith & Nephew: IP royalties, paid consultant; research support; Journal of Knee Surgery: editorial or governing board; Orthopaedic Techniques in Sports Medicine: editorial or governing board. JJI reports the following disclosures: receives funding as PI from Department of Defense Congressionally Directed Medical Research Programme Peer Reviewed Orthopaedic Research Programme for the Surgical Timing and Rehabilitation (STaR) Trial for Multiple Ligament Knee Injuries (MLKIs): A Multicenter Integrated Clinical Trial (W81XWH-17-2-0073) and serves as President, Board of Directors for Movement Science Media/Journal of Orthopaedic and Sports Physical Therapy. GM reports the following disclosures: Smith & Nephew, IBSA: consultant; ISAKOS: committee member; JBJS and arthroscopy: editorial board; Smith & Nephew: fellowship funding. GFH III reports the following disclosures: Arthrex: consultant. MS reports the following disclosures: Arthrex: consultant and royalties; Stryker, USA Hockey Foundation: research funding; MEK reports the following disclosures: AANA: research committee; AOSSM: enduring education committee; Arthrex; Smith & Nephew: education funds; PMacD reports the following disclosures: Arthrex and Conmed: consultant; Arthrex, Conmed, Zimmer Biomet, Smith & Nephew, Ossur: research and fellowship support; KMC reports the following disclosures: BJSM: senior advisor. BL reports the following disclosures: Arthrex: consultant and royalties; JKS and KSSTA: editorial board; MJM reports the following disclosures: Smith & Nephew: paid speaker. KT reports the following disclosure: Deputy Editor: BJSM. TGM reports the following disclosures: Arthrex: speaker, consultant; CORR: editorial board. EV reports the following disclosures: Associate Editor: BJSM; Editor-in-Chief: BMJ Open SEM. AJK reports the following disclosures: Arthrex: consultant, IP royalties; JRF Orthopaedics, Vericel, Responsive Arthroscopy: consulting fees; DJO: grants; Musculoskeletal Transplant Foundation: board of trustees. RCS reports the following disclosures: Arthrex: education; Editorial Board: AJSM and JBJS. JPS reports the following disclosures: Thieme: Publishing Royalties; DePuy: consulting fees/teaching courses; Arthrex: consulting fees/teaching courses; AO NA: research support, teaching and travel support; AO Foundation: teaching/travel support; Journal of Knee Surgery: Editor-in-Chief. CE reports the following disclosures: Canadian Institutes of Health Research, Canada Foundation for Innovation, Canada Research Chairs Programme and National Football League Play Smart Play Safe Programme: peer-reviewed research support; Associate Editor: BJSM; External Advisory Board: HitIQ Chairperson: Sport Injury Prevention Research Centre, an IOC Research Centre for Prevention of Injury and Protection of Athlete Health. HG reports the following disclosures: Associate Editor: BJSM, JOSPT. RGM reports the following disclosures: Mend nutrition. Royalties from Springer and Demos for books. JLC reports the following disclosures: AANA: research support; AO Trauma: research support; Arthrex: IP royalties; paid consultant; research support; Bioventus: paid consultant; Boehringer Ingelheim: paid consultant; Collagen Matrix: paid consultant; research support; GE Healthcare: research support; Journal of Knee Surgery: editorial or governing board; Midwest Transplant Network: board or committee member; Musculoskeletal Transplant Foundation: board or committee member; IP royalties; research support; National Institutes of Health (NIAMS & NICHD): research support; OREF: research support; Orthopaedic Trauma Association: research support; PCORI: research support; Regenosine: research support; SITES Medical: research support; Thieme: publishing royalties, financial or material support; Trupanion: paid consultant. VM reports the following disclosures: Smith & Nephew, Newclip: consultant; Ostesys: Shareholder; Arthrex, Smith & Nephew: educational grants; ISAKOS: board or committee member; KSSTA: Deputy Editor-in-Chief. MTH reports the following disclosures: Knee Surgery Sports Traumatology Arthroscopy (KSSTA): Deputy Editor-in-Chief; APKASS journal, MLT journal, Arthroskopie, Das Knie (DKG): board or committee member; European Knee Associates (EKA): Past Chairman; ESSKA Milan 2020 and 2021: Scientific Chairman; ISAKOS: Arthroplasty Committee; ESSKA: Cartilage Committee; German Knee Society: board or committee member; Personalized Arthroplasty Society (PAS): 2nd vice president DepuySynthes, Smith & Nephew, Symbios, Medacta: cconsultant; DepuySynthes, Finceramica, Symbios, Mathys, Arthrex, SIWF, Deutsche Arthrose-Hilfe, Bangerter-Rhyner-Stiftung: research grants. NM, HP, SPE, KDS, CJW, FRN, MT, DCCJvR, EK, DBW, MDM, GCF, CH, LE, RS and NP report no competing interests., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Physical activity in natural environments, such as trail running, is a way to nurture physical and mental health. However, running has an inherent risk of musculoskeletal injuries., Objectives: To investigate the prevalence of running-related injuries (RRI) and cramps, and to describe the personal and training characteristics of Brazilian trail runners., Methods: A total of 1068 trail runners were included in this observational cross-sectional study. The participants had at least six months of trail running experience. The data were collected between April 2019 and February 2020 through an online and self-reported survey., Results: The point prevalence of RRIs was 39.2 % (95 % credible interval [CrI]: 36.3, 42.1). The body region with the highest point prevalence was the knee. The 12-month period prevalence of RRIs was 69.2 % (95 %CrI: 66.4, 72.0). The body region with the highest 12-month period prevalence was the lower leg. 1- and 12-month period prevalence of cramps was 19.5 % (95 %CrI: 17.1, 21.9) and 36.0 % (95 %CrI: 33.0, 38.8), respectively. Triceps surae was the muscle most affected by cramps., Conclusions: Two in 5 (40 %) trail runners reported being injured at the time of data collection, and about 2 of 3 reported previous RRIs in the last 12 months. The most prevalent injured body regions were the knee and the lower leg. One in 5 trail runners reported cramps in the last month, increasing to 36 % in the last 12 months. Knowing better the characteristics of the population and the burden of health conditions may inform better decisions regarding implementation actions toward trail running practice., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2024 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: The aim of this study is to study the clinical decision-making practice of Italian physiotherapists in return to running (RTR) after anterior cruciate ligament (ACL) reconstruction, and the differences in decision-making in relation to physiotherapist's characteristics., Methods: An online survey was developed, 1404 physiotherapists were contacted by email, via chartered association, or via social media., Results: Most respondents (83%) indicated that the RTR decision should be made by a multidisciplinary team with RTR clearance around 3-4 months after surgery (47%). The most important criteria guiding the RTR decision were knee flexion range of motion (ROM) >130° (50%), complete extension ROM (95%), no pain (45%) and no effusion (68%). A Limb Symmetry Index (LSI) >70% for quadriceps (49%), hamstring (48%) and LSI >90% for posterolateral hip (45%) and triceps surae strength (42%) should be achieved for RTR. Approximately half of the participants (49%) do not consider ACL laxity tests to be used for RTR decisions. Response differences were found between sample subgroups. More experienced physiotherapists and those with post graduate training had lower thresholds to clear RTR., Conclusions: Experienced physiotherapists who treated a higher number of patients after ACL reconstruction, who had certified specialist training and a specific interest towards ACL rehabilitation, generally reported clinical practice modalities more in line with current evidence.

Background: The number of people who run to achieve competitive performance has increased, encouraging the scientific community to analyze the association of factors that can affect a runner performance., Research Question: Is there association between running spatiotemporal and angular kinematics with the physiological markers of endurance performance during a cardiorespiratory exercise test?, Methods: This was an observational cross-sectional study with 40 distance runners simultaneously submitted to a running biomechanical analysis and cardiorespiratory exercise test on a treadmill. Mixed models were developed to verify the association between angular kinematic data obtained by the Movement Deviation Profile and the running spatiotemporal data with oxygen consumption and ventilatory thresholds., Results: Spatiotemporal variables [.e., step frequency Odds Ratio 0.09 [0.06-0.12 95 % Confidence Interval], center of mass vertical displacement Odds Ratio 0.10 [0.07-0.14 95 % Confidence Interval], and step length [Odds Ratio -0.01 [-0.01 to -0.00 95 % Confidence Interval]] were associated with VO 2 . Also, step frequency Odds Ratio 1.03 [1.01-1.05 95 % Confidence Interval] was associated with the first ventilatory threshold, and angular running kinematics [Movement Deviation Profile analysis] Odds Ratio 1.47 [1.13-1.91 95 % Confidence Interval] was associated with peak of exercise during the cardiorespiratory exercise test., Significance: Our findings demonstrated that: both higher step frequency and center of mass vertical displacement are associated with the increase of oxygen demand; step frequency is associated with the first ventilatory threshold, due to the entrainment mechanism and angular kinematic parameters are associated with peak aerobic speed. Future studies could also compare the biomechanical and physiological characteristics of different groups of distance runners. This could help identify the factors that contribute to oxygen demands during running and performance across different ages, genders, and levels of competition., Competing Interests: Declaration of Competing Interest We the undersigned declare that this manuscript is original, has not been published before and is not currently being considered for publication elsewhere. We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. In so doing we confirm that we have followed the regulations of our institutions concerning intellectual property. We further confirm that any aspect of the work covered in this manuscript that has involved either experimental animals or human patients has been conducted with the ethical approval of all relevant bodies and that such approvals are acknowledged within the manuscript. We understand that the Corresponding Author is the sole contact for the Editorial process (including Editorial Manager and direct communications with the office). He is responsible for communicating with the other authors about progress, submissions of revisions and final approval of proofs. We confirm that we have provided a current, correct email address which is accessible by the Corresponding Author and which has been configured to accept email from the Gait and Posture Journal., (Copyright © 2024. Published by Elsevier B.V.)

Different aspects of the learning curve in total ankle replacement (TAR) have been studied in the short to mid-term, with 30 cases often considered critical. However, its impact on long-term (10- and 15-year) survival remains unclear. Therefore, we retrospectively analyzed 77 consecutive TARs performed by one orthopedic surgeon. The main outcome was long-term survival between cases 1-30 and 31-77 using the Kaplan-Meier with Competing Risk Analyses. Secondarily, we used Moving Average Method with LOESS regression to confirm the learning curve based on the perioperative complications. Thirdly, associations between perioperative complications and operation time on long-term survival were assessed using Cox proportional hazard models. The 10-year survival of cases 1-30 was 89.9% (95% CI 70.4-96.5), and of 31-77, 92.4% (95% CI 7745- 97.5) (p = .58). The 15-year survival was 81.8% (95% CI 59.5-91.8) and 74.8% (95% CI 52.4-86.6), respectively (p = .97). The long-term survival rate for the TAR that endured perioperative complication was 96.70% (95% CI 90.28-103.12), and for the uncomplicated TAR 87.50% (95% CI 77.12-97.88%) (p = .24). Operating time nor occurrence of perioperative fractures were significantly associated with long-term survival (p = .11 and 0.26, respectively). However, moving average method revealed a significant decreasing trend with a cut-off value of 33 procedures regarding the marginal probability of perioperative osseous complications (p < .01). In conclusion, surgeons should note a learning curve when adapting arthroplasty procedures. After the prosthesis design switch, the learning curve regarding perioperative osseous complications was confirmed at 33 TAR. The switch did not affect long-term survival., (Copyright © 2024 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The study aimed to evaluate the impact of neurocognitive reliance on jump distance and lower extremity kinematics in individuals who had undergone anterior cruciate ligament reconstruction (ACLR). This was achieved by comparing hop performance under standard and neurocognitive conditions., Methods: Thirty-two patients after ACLR and 32 healthy controls (CTRL) participated. Both groups performed a single-leg hop for distance (SLHD) and two neurocognitive hop tests, each designed to evaluate distinct aspects of neurocognition. The neurocognitive tests included the reaction SLHD (R-SLHD), measuring reaction to a central stimulus and working memory SLHD (WM-SLHD) assessing response to a memorized stimulus amidst distractor stimuli. Distances were assessed for the three-hop tests. In addition, joint kinematics were collected to calculate lower extremity coordination of the lower extremity. SLHD performance was defined as the mean hop distance per condition per leg for each participant and was analyzed using a mixed ANOVA with condition and leg as the within-subjects factors and the group (ACLR or CTRL) as the between-subjects factor. Differences in joint coordination variability were analyzed using two-sample t-test statistical parametric mapping (SPM) with linear regression., Results: The WM-SLHD resulted in a significantly decreased jump distance compared with the standard hop test both for ACLR and CTRL. Furthermore, the leg difference within the ACLR group increased under higher cognitive load as tested with the WM-SLHD, indicating leg-specific adaptations in lower extremity coordination., Conclusions: Neurocognitive single-leg hop tests resulted in reduced jump distance in CTRL and ACLR. The neurocognitive hop test revealed changes in coordination variability for the CTRL and the uninjured leg of ACLR individuals, whereas the injured leg's coordination variability remained unaltered, suggesting persistent cognitive control of movements post-ACLR., Level of Evidence: Level III., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Background: Injury and illness surveillance helps establish the infrastructure to provide adequate medical support at regattas and is the foundation for developing prevention strategies., Objectives: To assess the prevalence and characteristics of injuries in the 4 weeks before the start of the 2022 World Rowing Beach Sprints Finals (WRBSF) (the ' Prevalence Survey' ) and describe the incidence and nature of new-onset injuries and illnesses incurred during the WRBSF (the ' Incidence Survey' )., Methods: Athletes completed: (1) a prevalence survey recording injuries the 4 weeks before the WRBSF and (2) a recording of injuries and illnesses that occurred during the 3-day regatta., Results: Fifty-nine of 152 eligible WRBSF athletes completed the prevalence injury survey. Twenty-three (38.9%) reported experiencing at least one injury within the 4 weeks before the WRBSF. The most prevalent anatomical injury sites were the forearm (11.86%), lumbar spine (10.17%), knee (8.47%), ankle (6.78%) and hand/fingers (6.78%). During the competition, only two illness occurrences were reported; both were respiratory infections. Two athletes reported injuries: a hamstring strain and a concussion., Conclusion: Rowers presenting to the WRBSF described injuries leading up to the event that were similar to those common in classic rowing. Rowers at the event suffered injuries of the lower limb that were different from classic rowing and may be related to the addition of running to this event. An event concussion should be considered as a more likely injury in this type of rowing and future events should be prepared to manage such an injury., Competing Interests: JMD owns and operates Science of Rowing, LLC a digital publication that publishes reviews of rowing research., (Copyright © 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.)

Background/aim: The participation of individuals with physical impairment in sports has numerous benefits, yet there is also the risk of sustaining sport-related injuries or illnesses. Therefore, prevention programmes of these problems are needed to ensure that individuals can maintain a healthy, active lifestyle. Currently, very few prevention interventions are accessible for these athletes. Therefore, the article aims to describe the development process of the Tailored Injury Prevention in Adapted Sports intervention, an online tailored injury and illness prevention intervention for athletes with a physical impairment., Methods: The development was guided by the Knowledge Transfer Scheme (KTS)., Results: In the first step, a cohort study and a qualitative study were conducted to define the problem statement. In the second step, a systematic review was performed in order to learn from theory. Steps 3 and 4 involved an iterative process involving collaboration with diverse expert groups. This included defining athletes' needs and creating a health problem blueprint, after which the intervention content was created. To ensure accuracy and completeness, a feedback loop was incorporated. In the final phase of this step, we refined the language used within the intervention together with athletes. Finally, an effect and process evaluation will take place in the last step of the KTS., Conclusions: Through a five-step approach of the KTS, we developed an online injury and illness prevention intervention for athletes with a physical impairment. This intervention provides direct, timely feedback based on their current health status. Furthermore, it takes the sport and the physical impairment of the athletes into account with regard to the given prevention advices., Competing Interests: EV is the editor in chief of BMJ Open Sports and Exercise Medicine, and SCML is an associate editor of para sports and epidemiology of BMJ Open Sports and Exercise Medicine., (Copyright © 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.)

There are concerns over the impact of the congested international match calendar on professional footballers' physical and mental well-being, and injury susceptibility. This study aimed to determine whether there were differences in match workload and international travel between injured and non-injured male football players over two elite competition seasons. An observational, retrospective, case-control study was conducted using data from the 2021/2022 and 2022/2023 seasons of five top-tier European men's football leagues. Student t -tests were used to compare cumulative match workload and international travel data over a 28-day period preceding 1270 injuries and 2540 controls. There were significant differences in match workload and international travel variables between the injured groups (all injuries and hamstring injuries) and the control group. Match workload variables were higher ( p < 0.01), recovery variables lower ( p < 0.01), and international travel variables higher ( p < 0.01). An overload of match workload and international travel contribute to increased injury susceptibility in professional men's football. This emphasizes the need to address international match calendar concerns, including the number of games per season, the frequency of back-to-back games, and international travel requirements. Additionally, the findings highlight the importance of monitoring player match workloads, and implementing squad rotations and tailored training programs to mitigate injury risks.

Background: The influence of social determinants of health (SDH) on postoperative complications has been investigated in several studies, although correlation with Achilles tendon rupture (ATR) repair remains uninvestigated. SDH encompasses several factors, including insurance status and area-based measurements, including the Area Deprivation Index (ADI) and Social Vulnerability Index (SVI), which ranks neighborhoods by social disadvantage. This study investigated the correlation between patient demographics, SDH, and complications following ATR repair., Methods: A retrospective cohort study was conducted on 521 patients who presented with acute ATR and met the inclusion criteria, including age ≥18 years, a minimum of 30-day follow-up, and repair within 28 days of rupture. We reviewed patient demographics, time to surgery (TTS), and postoperative complications, including venous thromboembolism (VTE), rerupture, surgical site infection (SSI), wound dehiscence, and sural nerve injury. SDH variables included race, smoking status, insurance status, level of education, ADI, and SVI. Univariate regression tested the correlation between complications and SDH indicators. Significant variables ( P  < .05) were included in a multivariate regression., Results: Sixty-eight complications occurred in 59 patients (11.3%). Multivariate regression showed that a higher ADI, that is, socially deprived individuals, was associated with lower rates of VTE (OR = 0.41, P  = .04). Higher body mass index (BMI) was associated with rerupture (OR = 8.73, P  < .01). Male patients had lower rates of wound dehiscence (OR = 0.31, P  = .03) and VTE (OR = 0.32, P  = .02) compared with women. Longer TTS correlated with sural nerve injuries (OR = 2.23, P  < .01) and shorter TTS with reruptures (OR = 0.02, P   =  .02)., Conclusion: Some measures of SDH were associated with postoperative complications. Gender also may have an effect, with male sex associated with lower rates of wound dehiscence and VTE. BMI was associated with higher rates of reruptures and overall general complications., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Disclosure forms for all authors are available online.

Objective: To investigate the effect of an active choice (AC) intervention based on creating risk and choice awareness-versus a passive choice (PC) control group-on intentions and commitment to cardiovascular disease (CVD) risk-reducing behavior., Methods: Adults aged 50-70 (n = 743) without CVD history participated in this web-based randomized controlled trial. The AC intervention included presentation of a hypothetical CVD risk in a heart age format, information about CVD risk and choice options, and a values clarification exercise. The PC group received a hypothetical absolute numerical CVD risk and brief information and advice about lifestyle and medication. Key outcomes were reported degree of active choice, intention strength, and commitment to adopt risk-reducing behavior., Results: More AC compared to PC participants opted for lifestyle change (OR = 2.86, 95%CI:1.51;5.44), or lifestyle change and medication use (OR = 2.78, 95%CI:1.42;5.46), than 'no change'. No differences were found for intention strength. AC participants made a more active choice than PC participants (β = 0.09, 95%CI:0.01;0.16), which was sequentially mediated by cognitive risk perception and negative affect. AC participants also reported higher commitment to CVD risk-reducing behavior (β = 0.32, 95%CI:0.04;0.60), mediated by reported degree of active choice., Conclusions: Fostering active choices increased intentions and commitment towards CVD risk-reducing behavior. Increased cognitive risk perception and negative affect were shown to mediate the effect of the intervention on degree of active choice, which in turn mediated the effect on commitment. Future research should determine whether fostering active choice also improves risk-reducing behaviors in individuals at increased CVD risk in real-life settings., Trial Registration: ClinicalTrials.gov: NCT05142280. Prospectively registered., Competing Interests: The authors have declared that no competing interests exists, (Copyright: © 2024 Landais et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: To examine healthcare professionals (HCPs) attitudes, beliefs and preparedness towards the management of Para athlete mental health during the Tokyo 2020 and Beijing 2022 Paralympic Games., Methods: A cross-sectional observational study was conducted. National Paralympic Committee's HCPs (n=857) working at the Tokyo 2020 and Beijing 2022 Paralympic Games were invited to respond to an anonymous online survey regarding the management of Para athlete mental health in their team. Data were analysed using descriptive frequency statistics., Results: The survey was completed by 256 HCPs (30% of respondents). Most HCPs agreed that mental health was a concern in Para athletes (n=210; 82%). However, half (n=122; 48%) agreed that they did not screen Para athletes for mental health symptoms, and half (n=130; 51%) agreed that there was increased stigma around disclosure of mental health symptoms among Para athletes, compared with athletes without disability. Most HCPs (n=221; 86%) agreed they wanted to improve their knowledge and skills surrounding athlete mental healthcare. Culturally sensitivite, non-discriminatory and contextual factors were highlighted as desired areas of education for HCPs and active information dissemination for Para athletes., Conclusion: HCPs working at the Paralympic Games considered Para athlete mental healthcare important and reported perceived stigma, yet indicated low rates of mental health screening. Most respondents expressed the need for mental health education. Culturally sensitive training and active education strategies should be implemented to optimally manage Para athlete mental health., Competing Interests: Competing interests: All authors have declared no competing interests. WD is an associate editor of BJSM IPHP editions., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: High-performance snow sports (HPSS) athletes compete in a performance-driven context with a high risk of injury. While there is a lack of evidence on effective prevention measures in snow sports, this study explored the perspectives and perceptions of HPSS stakeholders on sports injury prevention., Methods: We conducted an exploratory qualitative study based on the grounded theory principles through 11 semistructured interviews with athletes, coaches and healthcare providers from different national teams about sports injury prevention. The interviews were inductively analysed through constant comparative data analysis., Results: Participants defined risk management as a central concept in which they approached injury prevention by assessing, managing and sometimes accepting risks. Many factors, such as athlete-related and external factors, are considered in this process, ultimately influencing their decision-making. Participants acknowledged the value of experience when managing and dealing with risks, a key aspect of their learning process and career development. Within this context, open and trustworthy communication and shared responsibilities among all stakeholders influenced and shaped injury prevention strategies and behaviours. Understanding and balancing out speed and risks was considered pivotal in their daily practice. Therefore, injury prevention awareness, ownership, communication, teamwork and shared responsibilities may contribute to the success of sports injury prevention in HPSS., Conclusion: These findings substantiate the significance of such contextual factors in sports injury prevention. Considering the high-risk nature of HPSS, injury prevention suggests a shift towards risk management strategies, with a strong emphasis on contextual factors and their interactions. Young athletes might benefit from educational interventions centred on developing skills to assess and manage risks., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To establish the prevalence of mental health symptoms (MHSs ) among Dutch elite athletes and their coaches, to examine the association between potential contributing factors and MHS among Dutch elite athletes and their coaches and to explore the view and needs of Dutch elite athletes and their coaches regarding mental health resources and support., Methods: A cross-sectional study was conducted by distributing an electronic questionnaire based on validated screening questionnaires for the assessment of MHS., Results: In total, 156 athletes (55 % female) and 95 coaches (79 % male) across various sports participated in this study. The most prevalent MHS among athletes and coaches were distress (73 % and 41 %) and alcohol misuse (52 % and 53 %). Adverse life events showed an association with anxiety, depression, sleep disturbance, alcohol misuse and disordered eating while severe injuries showed an association with distress and sleep disturbance in elite athletes. Among coaches, no significant associations were found between potential contributing factors and MHS. 60 % of the athletes and 60 % of the coaches (totally) agreed that they could openly address their mental health issues within their sport while 53 % of the athletes and 41 % of the coaches (totally) agreed a need for increased attention regarding mental health/guidance in their sport., Conclusions: MHSs are prevalent among Dutch elite athletes and coaches. Recent adverse life events and severe injuries have a potential intersection with MHS in elite athletes. There is a need for increased attention regarding mental health/guidance among Dutch elite athletes and coaches within their sport so that subsequent treatment/support can be provided., Competing Interests: None declared., (Copyright © 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.)

Background: Wheelchair tennis, a globally popular sport, features a professional tour spanning 40 countries and over 160 tournaments. Despite its widespread appeal, information about the physical demands of wheelchair tennis is scattered across various studies, necessitating a comprehensive systematic review to synthesise available data., Objective: The aim was to provide a detailed synthesis of the physical demands associated with wheelchair tennis, encompassing diverse factors such as court surfaces, performance levels, sport classes, and sexes., Methods: We conducted comprehensive searches in the PubMed, Embase, CINAHL, and SPORTDiscus databases, covering articles from inception to March 1, 2023. Forward and backward citation tracking from the included articles was carried out using Scopus, and we established eligibility criteria following the Population, Exposure, Comparison, Outcome, and Study design (PECOS) framework. Our study focused on wheelchair tennis players participating at regional, national, or international levels, including both juniors and adults, and open and quad players. We analysed singles and doubles matches and considered sex (male, female), sport class (open, quad), and court surface type (hard, clay, grass) as key comparative points. The outcomes of interest encompassed play duration, on-court movement, stroke performance, and physiological match variables. The selected study designs included observational cross-sectional, longitudinal, and intervention studies (baseline data only). We calculated pooled means or mean differences with 95% confidence intervals (CIs) and employed a random-effects meta-analysis with robust variance estimation. We assessed heterogeneity using Cochrane Q and 95% prediction intervals., Results: Our literature search retrieved 643 records, with 24 articles meeting our inclusion criteria. Most available information focused on international male wheelchair tennis players in the open division, primarily competing in singles on hard courts. Key findings (mean [95% CI]) for these players on hard courts were match duration 65.9 min [55.0-78.8], set duration 35.0 min [28.2-43.5], game duration 4.6 min [0.92-23.3], rally duration 6.1 s [3.7-10.2], effective playing time 19.8% [18.9-20.7], and work-to-rest ratio 1:4.1 [1:3.7-1:4.4]. Insufficient data were available to analyse play duration for female players. However, for the available data on hard court matches, the average set duration was 34.8 min [32.5-37.2]. International male players on hard court covered an average distance per match of 3859 m [1917-7768], with mean and peak average forward speeds of 1.06 m/s [0.85-1.32] and 3.55 m/s [2.92-4.31], respectively. These players executed an average of 365.9 [317.2-422.1] strokes per match, 200.6 [134.7-299.0] per set, 25.4 [16.7-38.7] per game, and 3.4 [2.6-4.6] per rally. Insufficient data were available for a meta-analysis of female players' on-court movement and stroke performance. The average and peak heart rates of international male players on hard court were 134.3 [124.2-145.1] and 166.0 [132.7-207.6] beats per minute, and the average match heart rate expressed as a percentage of peak heart rate was 74.7% [46.4-100]. We found no studies concerning regional players or juniors, and only one study on doubles match play., Conclusions: While we present a comprehensive overview of the physical demands of wheelchair tennis, our understanding predominantly centres around international male players competing on hard courts in the open division. To attain a more comprehensive insight into the sport's physical requirements, future research should prioritise the inclusion of data on female and quad players, juniors, doubles, and matches played on clay and grass court surfaces. Such endeavours will facilitate the development of more tailored and effective training programmes for wheelchair tennis players and coaches. The protocol for this systematic review was registered a priori at the International Platform of Registered Systematic Review and Meta-analysis Protocols (Registration https://doi.org/10.37766/inplasy2023.3.0060 )., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objectives: To describe the frequency, type, and severity of health problems in long-track speed skating to inform injury prevention strategies., Methods: We prospectively collected weekly health and sport exposure data on 84 highly trained Dutch athletes aged 15-21 years during the 2019/2020 season using the Oslo Sports Trauma Research Centre questionnaire on Health Problems and the trainers' documentation. We categorised health problems into acute or repetitive mechanisms of injury or illness and calculated incidences (per 1000 sports exposure hours), weekly prevalence and burden (days of time loss per 1000 sports exposure hours) related to the affected body region., Results: We registered 283 health problems (187 injuries, 96 illnesses), yielding an average weekly prevalence of health problems of 30.5% (95% CI 28.7% to 32.2%). Incidence rates were 2.0/1000 hours for acute mechanism injuries (95% CI 1.5 to 2.5) and 3.2/1000 hours for illnesses (95% CI 2.6 to 3.9). For acute mechanism injuries the head, shoulder and lumbosacral region had the highest injury burden of 5.6 (95% CI 4.8 to 6.5), 2.9 (95% CI 2.3 to 3.5) and 2.2 (95% CI 1.7 to 2.8) days of time loss/1000 hours, respectively. For repetitive mechanism injuries, the knee, thoracic spine, lower leg and lumbosacral region had the highest injury burden, with 11.0 (95% CI 9.8 to 12.2), 6.8 (95% CI 5.9 to 7.7), 3.9 (95% CI 3.2 to 4.6) and 2.5 (95% CI 1.9 to 3.1) days of time loss/1000 hours, respectively., Conclusion: Our study demonstrated a high prevalence of acute and repetitive mechanism injuries in speed skating. These results can guide future research and priorities for injury prevention., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Context: Participation in sports is associated with a risk of sports-related health problems. For athletes with an impairment, sports-related health problems further burden an already restricted lifestyle, underlining the importance of prevention strategies in para-sports., Objective: To provide a comprehensive overview with quality assessment of the literature on sports-related health problems, their etiology, and available preventive measures in para-sports following the steps of the Sequence of Prevention., Data Sources: A literature search (in PubMed, Embase, SPORTDiscus, CINAHL and the Cochrane Library) was performed up to December 8, 2021, in collaboration with a medical information specialist., Study Selection: The search yielded 3006 articles, of which 64 met all inclusion criteria., Study Design: Systematic review with quality assessment., Level of Evidence: Level 3., Data Extraction: Two independent researchers carried out the screening process and quality assessment. One researcher extracted data, and the Sequence of Prevention categorized evidence., Results: A total of 64 studies were included, of which 61 reported on the magnitude and risk factors of sports-related health problems, while only 3 reported on the effectiveness of preventive measures. Of these, 30 studies were of high quality. Most studies (84%) included elite-level athletes. The reported injury incidence varied widely between sports (0-91 per 1000 athlete days) and impairment categories (1-50 per 1000 athlete days). The same applies to illness incidence with regard to different sports (3-49 per 1000 athlete days) and impairment categories (6-14 per 1000 athlete days)., Conclusion: This review shows the current vast range of reported sport-related health problems in para-sports. There is limited evidence concerning the severity of these sports-related health problems and inconclusive evidence on the risk factors. Lastly, the evidence regarding the development and effectiveness of preventive measures for para-athletes is sparse., Competing Interests: The authors report no potential conflicts of interest in the development and publication of this article.

Background: Concussions in Rugby Union are common with an increased risk to adolescent players. Coaches are key to injury prevention and a greater understanding of their knowledge and sentiments may guide future initiatives. There is a lack of data on rugby coaches, especially in South Africa. This study aimed to investigate the knowledge and opinions of high school rugby coaches regarding concussion management., Methods: This cross-sectional study of 37 high school rugby coaches in South Africa, was conducted via a self-reported questionnaire. Concussion knowledge was scored for correct answers only with closed-question scaling methods to measure the importance of items of concussion management using a graphical rating scale. An attitude scale (Likert) was used to assess self-reported opinions and behaviours. Associations were calculated for participant characteristics and overall concussion injury knowledge., Results: More participants showed good overall knowledge of ≥ 75% (n = 22, 59% vs. n = 15, 40%), especially those with greater coaching experience (p = 0.021). Player welfare was perceived more important than player performance (185 vs. 164), with concussion prevention most important (184 of 185). Appealing characteristics of an injury prevention programme were the improvement of player skill (173, SD ± 0.75, mean 4.68), being adaptable (171, ± 0.86, 4.62), and being completed in the warm-up (167, ± 0.93, 4.51). The biggest perceived barriers were duration (138, ± 1.59, mean 3.73), effort (130, ± 1.56, 3.51), compliance and lack of knowledge (both 127, ± 1.68, 3.43)., Conclusion: These results support the implementation of ongoing concussion education for rugby coaches and identify areas for promoting awareness and knowledge of concussion injury prevention, identification, and specific management of younger athletes. Appealing characteristics and barriers are highlighted and may allow for improved implementation and adherence to concussion prevention programmes., (© 2024. The Author(s).)

Objectives: Trail running is a popular off-road sport involving running in natural environments over various terrains, often in remote locations. This study aims to investigate the epidemiology and risk factors of injuries and illnesses, i.e. medical encounters, on race day among trail runners in a high-altitude ultra trail race., Methods: This descriptive cross-sectional study on an ultra trail race (38 km, 65 km and 100 km) in South Africa, included participants 18 years or older. Of the 331 race participants, 285(86.1%) consented to participate in the study. Data collection included demographic details, injuries (body region, specific body area, tissue type, pathology) and illnesses (organ system, symptom cluster, etiology). Risk factor analysis includes sex, age, weight, height, race distance, illness and injury history, training and running experience. Frequency (n, %), prevalence (%) and odds ratios (OR; 95%CI) are reported., Results: Eighty-nine (31.2%) individuals reported 131 medical encounters [49 injuries (37.4%); 82 illnesses (62.6%)]. Injuries were sustained by 14.7% of athletes, and 22.5% reported illnesses. For injuries, the lower limb was mainly involved ( n  = 41; 83.7%). Most injuries affected the foot ( n  = 18; 36.7%), ankle ( n  = 10; 20.4%) and knee ( n  = 7; 14.3%). Tissue types mainly involved skin ( n  = 21; 42.8%), ligament ( n  = 7; 14.3%) and muscle ( n  = 7; 14.3%). Multiple ( n  = 45; 54.9%) and gastrointestinal ( n  = 17; 20.7%) organ systems were mainly involved in illnesses. Only 100 km runners reported dehydration ( n  = 28; 31.5%), and one in every six of these runners ( n  = 5; 17.9%) did not finish. Runners reporting fatigue ( n  = 21; 23.6%) had a high ( n  = 8; 38.1%) did not finish rate. Two in every five participants ( n  = 36; 40.4%) with a medical encounter, did not finish. No medical encounter-associated risk factors were identified., Conclusions: Illnesses were more common than injuries during the mountainous ultra trail race. Sustaining a medical encounter increased the chance of not completing the race. Further research on the epidemiology of race day medical encounters in trail running is required.

This study explored stakeholders' perspectives on current practices, challenges and opportunities related to the return-to-sport (RTS) process in high-performance Snowsports. We conducted fourteen semi-structured interviews with athletes, coaches and health professionals from multiple countries using online video platforms. The data were transcribed verbatim and analysed based on constant comparative analysis employing the principles of Grounded Theory. Codes were grouped into categories and main concepts and a conceptual model were derived. According to the participants, RTS should be considered a continuous process to bring the athlete back to competition as fast and safely as possible, whereas speed is often prioritised over safety. Participants described the need for a structured and criteria-based process. Despite the multiple phases and the diversity of involved professionals, the process is individualised and unique, highlighting the value of having the athlete at the centre of the RTS process. It was considered essential to provide a safe environment and build trustworthy relationships. Additionally, access to resources, communication and cooperation among all experts was perceived as critical to successful RTS. Our participants described the value of continuity and an athlete-centred approach to the RTS process. The challenges, such as interprofessional communication, the lack of objective sport-specific criteria, and the diversity of resources and network structures, were perceived as practical issues that influenced the process, which should be tailored for each athlete accordingly to reach a successful RTS., Competing Interests: Competing interests: EV and CB are members of the BMJ Open Sports & Exercise Medicine (BOSEM) Editorial Board., (© 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.)

Objective: To determine the neurocognitive function of active professional male footballers, determine whether deficits/impairments exist, and investigate the association between previous concussion(s) and neurocognitive function., Methods: An observational cross-sectional study conducted via electronic questionnaires. The CNS Vital Signs online testing system was used to evaluate neurocognitive function., Results: Of the 101 participants, 91 completed the neurocognitive function testing. Neurocognitive function domain deficits or impairments were unlikely in 54.5-89.1%, slight in 5.9-21.8%, moderate in 1.0-9.9%, and likely in 4.0-14.9% of participants. A history of zero concussions found a significant association between the neurocognitive index (Odds Ratio [OR] 0.6; 95% CI 0.2-0.4) and complex attention domain (OR 0.3; 95% CI 0.1-0.9), with 40% and 70% less odds, respectively, of deficit/impairment. Among the 54.5% who reported any number of concussions, there were increased odds of neurocognitive domain deficits/impairments for complex attention (CA) [3.4 times more] and simple attention (SA) [3.1 times more]., Conclusion: In the active professional male footballer, most neurocognitive functions do not have significant deficits/impairments. The odds of neurocognitive function deficit/impairment were significantly increased threefold for CA and SA in those who reported a history of any concussion(s).

Purpose: To provide return-to-performance outcomes after surgical treatment for medial malleolus stress fractures in the elite athlete. Additionally, to describe an individualised surgical approach in the management of medial malleolus stress fractures., Methods: Five athletes (six ankles) underwent surgical treatment for a medial malleolus stress fracture. The surgical technique was based on the extent of the fracture line in steps with first arthroscopic debridement of bony spurs, microfracturing of the fracture line and screw fixation. Return-to-performance data included time to return to sport-specific training, normal training, first competitive activity, performance and the return-to-performance rate., Results: Patients returned to sport-specific training at a median of 10 weeks. They started normal training at 16 weeks postoperatively and returned to their first competitive activity after 19 weeks. All patients had bony spurs on the distal tibia which were arthroscopically debrided. One patient received arthroscopic debridement of bony spurs alone. Four patients received additional microfracturing of the fracture line and three patients received screw fixation. All patients achieved clinical and radiographic union on follow-up computed tomography scan at 3 months postsurgery. At latest follow-up, no refractures nor hardware complications, nor any other complications were observed., Conclusion: Arthroscopic debridement of bony spurs, debridement and microfracturing of the fracture line and screw fixation are all viable surgical tools in the management of medial malleolus stress fractures in elite athletes. The surgical approach containing these options should be tailored to the individual athlete based on the fracture line in the sagittal plane. While most athletes return to full competitive activity in 3-4 months, time to self-reported return to full performance is often much longer., Level of Evidence: Level IV., (© 2024 The Author(s). Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Objective: This paper presents an exploratory case study focusing on the applicability and value of process mining in a professional sports healthcare setting. We explore whether process mining can be retrospectively applied to readily available data at a professional sports club (Football Club Barcelona) and whether it can be used to obtain insights related to care flows., Design: Our study used discovery process mining to detect patterns and trends in athletes' Post-Pre-Participation Medical Evaluation injury route, encompassing five phases for analysis and interpretation., Results: We examined preprocessed data in event log format to determine the injury status of athletes in respective baseline groups (healthy or pathological). Our analysis found a link between thigh muscle injuries and later ankle joint problems. The process model found three loops with recurring injuries, the most common of which were thigh muscle injuries. There were no differences in injury rates or the median number of days to return to play between the healthy and pathological groups., Conclusions: This study explored the applicability and value of process mining in a professional sports healthcare setting. We established that process mining can be retrospectively applied to readily available data at a professional sports club and that this approach can be used to obtain insights related to sports healthcare flows., Competing Interests: Competing interests: Ramon Pi-Rusiñol and Gil Rodas work at the FC Barcelona Medical Department. Evert Verhagen is the Editor-in-Chief of BMJ Open Sport & Exercise Medicine., (© 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.)

Objective: To calculate the prevalence rates of mental health symptoms among female professional football players over a 12-month period and to explore the associations of severe injury and related surgery with mental health symptoms among female professional footballers., Methods: An observational prospective cohort study was conducted over a 12-month follow-up period by distributing an electronic questionnaire three times. The questionnaire was based on validated screening tools for assessing mental health symptoms., Results: A total of 74 female professional football players participated in this study. Mental health symptoms ranged from 1% for substance misuse to 65% for sport-psychological distress at baseline, from 6% for anxiety to 53% for sport-psychological distress 6 months postbaseline and from 3% for substance misuse to 55% for sport-psychological distress 12 months postbaseline. The prevalence of disordered eating remained between 15% and 20% over the 12-month period. Only one of the associations was statistically significant. Female professional football players were nearly twice as likely to report sport-related psychological distress following every surgery., Conclusions: The substantial prevalence of mental health symptoms among female professional football players emphasises the need for increased attention, awareness and interventions. Additionally, female professional football players are nearly twice as likely to report sport-related psychological distress after each surgery. Sports medicine physicians and mental health professionals working in female football should provide standard care, which involves identifying, monitoring and implementing tailored interventions for mental health symptoms., Competing Interests: Competing interests: None declared., (© 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.)

Background: The development and application of Artificial Intelligence (AI) and Machine Learning (ML) in healthcare have gained attention as a promising and powerful resource to change the landscape of healthcare. The potential of these technologies for injury prediction, performance analysis, personalized training, and treatment comes with challenges related to the complexity of sports dynamics and the multidimensional aspects of athletic performance., Objectives: We aimed to present the current state of AI and ML applications in sports science, specifically in the areas of injury prediction, performance enhancement, and rehabilitation. We also examine the challenges of incorporating AI and ML into sports and suggest directions for future research., Method: We conducted a comprehensive literature review, focusing on publications related to AI and ML applications in sports. This review encompassed studies on injury prediction, performance analysis, and personalized training, emphasizing the AI and ML models applied in sports., Results: The findings highlight significant advancements in injury prediction accuracy, performance analysis precision, and the customization of training programs through AI and ML. However, future studies need to address challenges such as ethical considerations, data quality, interpretability of ML models, and the integration of complex data., Conclusion: AI and ML may be useful for the prevention, detection, diagnosis, and treatment of health conditions. In this Masterclass paper, we introduce AI and ML concepts, outline recent breakthroughs in AI technologies and their applications, identify the challenges for further progress of AI systems, and discuss ethical issues, clinical and research opportunities, and future perspectives., Competing Interests: Declaration of competing interest The authors declare no competing interest., (Copyright © 2024 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: We investigated the perspective on workload within the Royal Netherlands Marechaussee, part of the Dutch armed forces., Methods: This qualitative study follows an emergent design based on grounded theory principles and used semistructured interviews and focus groups with 91 Royal Netherlands Marechaussee employees. The interviews ( n = 31) and focus groups ( n = 14) were transcribed verbatim and analyzed by two researchers (C.B. and J.v.d.Z.) according to comparative data analysis., Results: Participants believed the perception of workload to be more important than the actual workload. Furthermore, participants mentioned that indirect factors, such as organizational factors and recruitment, could modulate their workload perception., Conclusions: The perception of workload is key within the context of the Royal Netherlands Marechaussee. Modifiable factors related to the perceived workload could facilitate employee well-being without reducing the actual workload., Competing Interests: Conflicts of interests: None declared., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Occupational and Environmental Medicine.)

The purpose of this study was to i) determine the prevalence of anxiety/depression symptoms in professional cricketers and ii) identify factors associated with symptoms of anxiety/depression. One-hundred and seventy-seven (n = 177, response rate of 76%) professional cricketers completed the General Health Questionnaire 12 (GHQ-12). Odd ratios (OR) for anxiety/depression symptoms were related to players' career, family and education. Prevalence of symptoms of anxiety/depression was 59% (n = 104/177). Anxiety/depression symptoms increased when players were contracted for more than 2 years (OR: 5.0; 95% CI: 1.2-21.3; p = 0.028) and if they played their last offseason overseas (OR: 3.5; 95% CI: 1.3-9.6; p = 0.013). Anxiety/depression symptoms decreased by 70% when players made "productive use" of their time in the offseason (OR: 0.3; 95% CI: 0.1-0.9; p = 0.036) and contracted for 2 years (OR: 0.3; 95% CI: 0.1-1.0; p = 0.049). These findings can be incorporated into cricket mental health literacy programmes to improve awareness and understanding, and to encourage early help-seeking.

Objectives: Shared decision-making (SDM) is a trending topic in athlete health care; however, little is known about its use in a sports context. This study aimed to measure knowledge and self-perceived practice of SDM among healthcare professionals working with athletes. This study evaluates SDM attitudes and preferences and explores how healthcare professionals perceive the factors influencing SDM., Methods: A web-based cross-sectional survey with open-ended and closed-ended questions., Results: Our survey was completed by 131 healthcare professionals. The majority (63.6%) reported to prefer SDM and to be confident in their SDM skills (81.1%). Despite this inclination and confidence, only one in four clinicians reported consistent practice of SDM when feasible. Additionally, most clinicians lacked SDM knowledge. The barriers perceived by healthcare professionals included time constraints (17.6%), limited patient knowledge (17.6%), limited patient motivation (13.5%) and language barriers (16.2%). Importantly, two-thirds of the participants believed that SDM in athlete health care differs from SDM in non-athletes due to the high-pressure environment, the tension between performance and health, and the involvement of multiple stakeholders with potentially conflicting interests., Conclusions: Although healthcare professionals preferred SDM, they did not fully understand nor routinely practice it. Most healthcare professionals perceive SDM in athlete health care to differ from SDM in the general population. Therefore, to inform the implementation of SDM in athlete health care, future research is crucial to understand better what makes practising SDM unique in this setting., Competing Interests: Competing interests: SN, HPD, OD and AF declare they have no competing interests. EV is Editor-in-Chief of BMJ Open SEM., (© 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.)

Background: The International Olympic Committee (IOC) Medical and Scientific Commission has supported collating and sharing evidence globally by developing sports medicine consensus statements ('Statements''). Publishing the Statements requires substantial resources that must be balanced by use and impact on policy and practice. This study aimed to gain a better understanding of awareness and uptake of the Statements globally through a survey of the National Olympic Committees (NOC), National Paralympic Committees (NPC) and International Federations (IF)., Method: A cross-sectional survey of medical commission representatives from NOCs/NPCs/IFs. A structured questionnaire was distributed through the IOC head office, informed by prior research. Questions comprised a mix of closed and open-text responses with results presented descriptively by organisation type and total., Results: 55 responses were included: 29 (52%) from NOC/NPC representatives (response rate 14%) and 26 (47%) from IF representatives (response rate 63%). All Statements had been used by at least one respondent, with the Statement addressing concussion ranked highest (used by 33/55). The main barriers to use were financial limitations (n=21), club/sport culture and behaviours (n=19) and lack of understanding from coaches/team sport personnel (n=19). Participants believed the Statements were a successful strategy for improving athlete health (n=39/51 agree or strongly agree)., Conclusion: There was clear support for the continued development of sports medicine guidance, including in the format of these Statements. To ensure Statements lead to demonstrable health benefits for athletes, input from athletes, coaches and supporting staff is needed, as well as clearer identification of the purpose and audience of each topic developed., Competing Interests: Competing interests: All authors are members of a centre affiliated with the IOC Medical Research Network, recognised for their research into the protection of athlete health research. Early results were presented and discussed in two meetings linked to the network, with attendance from representatives of 11 research centres and the IOC Medical and Scientific Commission. Neither the IOC nor its Medical Commission contributed to details and decisions about the study design, its conduct or the interpretation and discussion of results., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Context: Baseball pitching requires fast and coordinated motions of the whole body to reach high ball speeds, putting considerable strain on the musculoskeletal system, particularly the shoulder and elbow., Design: Descriptive epidemiology study., Objective: To describe musculoskeletal symptoms and the functional status of the shoulder and elbow in male high school baseball pitchers., Setting: Dutch baseball talent academies., Patients or Other Participants: 125 male high school baseball pitchers aged 12 to 18 years, who participated in one of the six Dutch baseball talent academies and the Dutch National U-18 team were recruited and enrolled., Main Outcome Measure(s): Musculoskeletal symptoms, functional status of the shoulder and elbow were registered for each player every six months over two consecutive baseball seasons through self-assessment questionnaires, including the Kerlan-Jobe Orthopaedic Clinic (KJOC) and the Western Ontario Shoulder Instability Index (WOSI) questionnaires., Results: 570 musculoskeletal (MSS) symptoms in 93 of the 125 players were reported. The average six-month prevalence for symptoms of the throwing shoulder was 37% (95% CI: 33% - 41%), and for the elbow 37% (95% CI: 31% - 42%), followed by the lower back with 36% (95% CI: 26% - 45%). The baseball pitchers who experienced only shoulder symptoms had an average KJOC score of 80.0 (95% CI: 75.3-84.7) points, while those with only elbow symptoms reported a score of 90.2 (95% CI: 89.2-95.3). On the WOSI questionnaire, baseball pitchers scored an average of 421.2 (95% CI: 200.1 - 642.4) points., Conclusion: In a cohort of Dutch high school baseball pitchers, one-third reported shoulder and elbow symptoms on the throwing side, with reduced functional status and lower back symptoms. Future efforts should focus on developing preventive strategies through early symptom detection, aiming to prevent symptom progression and, ultimately, the development of severe injuries.

Introduction: After anterior cruciate ligament (ACL) reconstruction, determining readiness to return to participation is challenging. The understanding of which neuromuscular performance parameters are associated with limb symmetry and self-reported symptoms may be useful to improve monitoring the rehabilitation towards adequate decision-making to return., Objectives: To compare the ACL-operated and injury-free lower limbs regarding functional performance; and to investigate whether lower limb strength and functional performance are associated with self-reported symptoms and functional lower limb symmetry., Method: Thirty-four participants were included. Functional performance was assessed by using the Y-Balance test, Single-leg Hop, and Functional Movement Screen. An isokinetic dynamometer was used to evaluate the strength levels in open and closed kinetic chains. The functional lower limb symmetry was calculated considering the single-leg hop test results for each lower limb., Results: There were no differences in dynamic balance (Y-Balance) between the operated and injury-free limbs. The operated limb presented a worst performance in the single-leg hop. Self-reported symptoms prevalence and lower limb symmetry were associated with knee extension strength and functional performance (Y-Balance)., Conclusion: Individuals submitted to ACL-reconstruction presented worse functional performance in the operated limb compared to the injury-free limb. Both knee strength and dynamic balance were associated with limb symmetry and self-reported symptoms., Competing Interests: Declaration of competing interest None to declare., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Long-track and short-track ice speed skating are integral to the Winter Olympics. The state of evidence-based injury prevention in these sports is unclear. Our goals were to summarize the current scientific knowledge, to determine the state of research, and to highlight future research areas for injury prevention in ice speed skating. We conducted a scoping review, searching all injury and injury prevention studies in competitive ice speed skaters. The six-stage Translating Research into Injury Prevention Practice (TRIPP) framework summarized the findings. The systematic search yielded 1109 citations. Nineteen studies were included, and additional searches yielded another 13 studies, but few had high-quality design. TRIPP stage 1 studies (n = 24) found competition injury rates from 2% to 18% of participants with various injury locations and types. Seasonal prevalence of physical complaints was up to 84% (for back pain) in long- and short-track. Ten studies covered information on TRIPP stage 2, with two small etiological studies linking injuries to functional strength deficits (short-track) and training load (long-track). Questionnaire studies identified various perceived risk factors for injuries but lacked further scientific evidence. Most TRIPP stage 3 studies (five out of eight) focused on developing protective measures, while two studies found short-track helmets performed poorly compared to helmets used in other sports. No study evaluated the efficacy, the intervention context, or the effectiveness (TRIPP stages 4-6) of the measures. Scientific knowledge on injury prevention in ice speed skating is limited. Future research should prioritize high-quality studies on injury epidemiology and etiology in the sports., (© 2024 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Purpose: This study aims to evaluate the clinical outcomes of arthroscopic autologous matrix-induced chondrogenesis (A-AMIC) for osteochondral lesions of the talus (OLT) at 24 months and 60 months of follow-up. The secondary aim was to assess whether age, body mass index (BMI), and lesion surface affect outcomes., Design: Sixty-three patients (32 males, 31 females) with a median age of 37 years [interquartile range (IQR): 25-48] were included. Preoperative and postoperative (24 months and 60 months) clinical outcomes were evaluated using a Visual Analog Score (VAS) for pain during walking, the American Orthopaedic Foot and Ankle Society (AOFAS), Short-Form Survey (SF-12), the Halasi, and the University of California, Los Angeles (UCLA) scores. Patients were categorized according to age, BMI, and lesion surface (1-1.5 cm 2 and over 1.5 cm 2 ). The effect of each category was evaluated., Results: There were significant improvements in the VAS, AOFAS, SF-12, and UCLA, comparing the preoperative scores to the 60-month follow-up scores ( P < 0.001). There were no significant differences in the above-mentioned outcomes between the follow-up periods. Patients older than 33 years had lower SF-12, Halasi, and UCLA scores ( P = 0.005, 0.004, and <0.001, respectively). Overweight patients had lower VAS, SF-12, Halasi, and UCLA scores ( P = 0.006, 0.002, 0.024, and 0.007, respectively). Lesion size was uninfluential., Conclusion: A-AMIC yielded clinical improvements at a minimum follow-up of 60 months in patients with symptomatic OLTs, with clinical improvement peaking in the first 2 years, followed by a plateau period. Increased age and BMI were significantly associated with inferior outcomes., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To investigate whether and how a single traumatic impact changes the mechanical properties of talar articular cartilage., Design: A marble was placed on the joint surface and a weight was dropped on both medial and lateral caprine talus to create a well-defined single focal impact. The mechanical properties of intact and impacted talar cartilage were measured with a micro-indenter. Elastic (storage) and viscous (loss) moduli were determined by oscillatory ramp and dynamic mechanical analysis protocols., Results: We found significant differences between ankles and within the same ankle joint, with the medial talus having significantly higher storage- and loss moduli than the lateral talus. The storage- and loss moduli of intact articular cartilage increased with greater indentation depths. However, postimpact the storage- and loss moduli were significantly and consistently lower in all specimens indicating immediate posttraumatic damage. The deeper regions of talar cartilage were less affected by the impact than the more superficial regions., Conclusions: A single traumatic impact results in an immediate and significant decrease of storage- and loss moduli. Further research must focus on the development of non- or minimally invasive diagnostic tools to address the exact microdamage caused by the impact. We speculate that the traumatic impact damaged the collagen fibers that confine the water-binding proteoglycans and thereby decreasing the hydrostatic pressure of cartilage. As part of the treatment directly after a trauma, one could imagine a reduction or restriction of peak loads to prevent the progression of the cascade towards PTOA of the ankle joint., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Currently, the knowledge about the epidemiology of sport-related health problems of athletes with a physical impairment is limited. Therefore, this study aims to describe the prevalence, incidence and severity of sport-related health problems of athletes with a physical impairment in the Netherlands over a one sport season., Design: Prospective cohort study., Methods: Athletes (n = 99) with a physical impairment participated in this study. After completing a baseline questionnaire, athletes started a 40-week health monitoring period, during which they completed the Dutch translation of the OSTRC Questionnaire on Health Problems every week. Based on the reported information, injury and illness prevalence, incidence, weekly cumulative severity score, weekly time loss from sport and the total burden were calculated., Results: A total of 368 health problems were reported by 95 athletes. These health problems consisted of 258 injuries and 110 illnesses. The average weekly prevalence of health problems was 48.0 %; for injuries 34.6 %, and illnesses 13.4 %. Differences were found when considering injury severity, with the highest severity scores for athletes with a limb deficiency. Furthermore, recreational athletes reported the highest injury severity scores, followed by athletes who competed nationally and athletes who competed internationally., Conclusions: Data from this study show a high average weekly prevalence of health problems, and differences amongst various impairment categories and sport levels when considering the severity of injuries. These results add to the knowledge regarding sport-related health problem epidemiology in this population, indicating that impairment category and sport level should be taken into account when developing injury prevention strategies., Competing Interests: Declaration of interest statement All authors declare that they have no conflicts of interest relevant to the content of this article., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)