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Clinical Scenario: Individuals with chronic ankle instability (CAI) typically complete balance training protocols to improve postural control and reduce recurrent injury risk. However, the presence of CAI persists after traditional balance training protocols suggesting that such programs may be missing elements that could be beneficial to patients. Visual occlusion modalities, such as stroboscopic goggles, may be able to augment balance training exercises to further enhance postural control gains in those with CAI. However, a cumulative review of the existing evidence has yet to be conducted. Focused Clinical Question: Does wearing stroboscopic goggles during balance training result in greater improvements to postural control than balance training alone in those with CAI? Summary of Key Findings: All 3 studies indicated that the stroboscopic goggles group had statistically significant improvements in either a measure of static or dynamic postural control relative to the standard balance training group. However, significant improvements were not consistent across all postural control outcomes assessed in the included studies. Clinical Bottom Line: Postural control may improve more in those with CAI when stroboscopic goggles were worn while completing balance training exercises relative to completing balance training exercises alone. Strength of Recommendation: Overall, consistent moderate- to high-quality evidence was present in the 3 studies, suggesting grade C evidence for the use of stroboscopic goggles during balance training in those with CAI. [ABSTRACT FROM AUTHOR]

Imbalanced joint load distribution across the tibiofemoral surface is a risk factor for osteoarthritic changes to this joint. Lateral wedge insoles, with and without arch support, are a form of biomechanical intervention that can redistribute tibiofemoral joint load, as estimated by external measures of knee load. The objective of this study was to examine the effect of these insoles on the internal joint contact characteristics of osteoarthritic knees during weightbearing. Fifteen adults with tibiofemoral osteoarthritis underwent magnetic resonance imaging of the affected knee, while standing under 3 insole conditions: flat control, lateral wedge alone, and lateral wedge with arch support. Images were processed, and the surface area and centroid location of joint contact were quantified separately for the medial and lateral tibiofemoral compartments. Medial contact surface area was increased with the 2 lateral wedge conditions compared with the control (P ≤.012). A more anterior contact centroid was observed in the medial compartment in the lateral wedge with arch support compared with the lateral wedge alone (P =.009). Significant changes in lateral compartment joint contact outcomes were not observed. These findings represent early insights into how loading at the tibiofemoral interface may be altered by lateral wedge insoles as a potential intervention for knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Gait asymmetry is a predictor of fall risk and may contribute to increased falls during pregnancy. Previous work indicates that pregnant women experience asymmetric joint laxity and pelvic tilt during standing and asymmetric joint moments and angles during walking. How these changes translate to other measures of gait asymmetry remains unclear. Thus, the purpose of this case study was to determine the relationships between pregnancy progression, subsequent pregnancies, and gait asymmetry. Walking data were collected from an individual during 2 consecutive pregnancies during the second and third trimesters and 6 months postpartum of her first pregnancy and the first, second, and third trimesters and 6 months postpartum of her second pregnancy. Existing asymmetries in step length, anterior–posterior (AP) impulses, AP peak ground reaction forces, lateral impulses, and joint work systematically increased as her pregnancy progressed. These changes in asymmetry may be attributed to pelvic asymmetry, leading to asymmetric hip flexor and extensor length, or due to asymmetric plantar flexor strength, as suggested by her ankle work asymmetry. Relative to her first pregnancy, she had greater asymmetry in step length, step width, braking AP impulse, propulsive AP impulse, and peak braking AP ground reaction force during her second pregnancy, which may have resulted from increased joint laxity. [ABSTRACT FROM AUTHOR]

Context: An easy-to-administer, function-based questionnaire to assess patients with various foot problems was required for a Greek-speaking population. This study aimed to translate and cross-culturally adapt the Quick Foot and Ankle Ability Measure (Quick-FAAM) into Greek and evaluate its reliability and validity. Design: Cross-sectional study. Methods: Established international guidelines for the cross-cultural adaptation of questionnaires were followed. The face and content validity of the Greek version of the Quick-FAAM (Quick-FAAM-GR), as well as the internal consistency and test-retest reliability upon repeated administration after 5 days, were examined. In addition, the construct validity of the scale was examined via exploratory factor analysis as well as by testing for associations with the Manchester Foot Pain and Disability Index, the 12-item Short-Form Survey (version 2), and a functional balance assessment test--the Y-Balance Test. Results: Sixty participants (18 women) with self-reported chronic ankle instability symptoms, with a median (interquartile range) age of 27 (7.7) years, participated in the study. Half of the participants were included in the test-retest reliability study. The Quick-FAAM-GR demonstrated face and content validity. Excellent internal consistency (Cronbach a =.961) and intrarater test-retest reliability (intraclass correlation coefficient ICC[2,1] = .93) were demonstrated, with a comparable error margin to the original version (standard error of the measurement = 2.1, 95% minimum detectable change = 5.9). Associations of the Quick-FAAM-GR scores to other questionnaires ranged from weak to strong (Spearman rho), all being statistically significant (Manchester Foot Pain and Disability Index from -.26, P = .04, to -.67, P< .001, and 12-item Short-Form Survey, version 2, between .41 and .72, P<.001), and to the Y-Balance Test between lower-limb differences (-.35 to -.58, P< .001). The exploratory factor analysis confirmed the single- factor structure of this scale. No floor/ceiling effects were observed. Conclusions: The Greek Quick-FAAM has proven to be a valid and reliable tool for evaluating chronic ankle instability and can be used for clinical and research purposes in Greek- speaking individuals. [ABSTRACT FROM AUTHOR]

Context: Decreased muscle strength and balance in patients with functional ankle instability (FAI) can be effectively improved by ankle strength training. Low-load blood flow restriction (LL-BFR) training increases muscle size and strength, but there is limited evidence from studies on muscle strength and balance in FAI patients. Objective: To study the effects of LL-BFR training versus high-load training (HLT) on muscle strength and balance in FAI patients. Design: Randomized controlled trial. Participants: Forty-six young adults with a history of FAI. Interventions: Participants in the LL-BFR and HLT groups performed 4 sets (30 x 15 x 15 x 15) of ankle training at 20% to 40% of the one-repetition maximum and 70% to 85% one-repetition maximum, respectively, twice a week for 6 weeks. Main Outcome Measure(s): Plantar flexion, dorsiflexion, inversion, and eversion muscle strength, and the Y-balance test scores were assessed at baseline and after 3 and 6 weeks; the thickness of the tibialis anterior, triceps surae, and peroneus longus muscles were assessed at baseline and after 6 weeks. Results: Inversion, eversion, dorsiflexion, and plantar flexion muscle strength; tibialis anterior, triceps surae, and peroneus longus thickness; and Y-balance test scores were significantly increased in the LL-BFR group after 3 and 6 weeks compared with baseline (P < .05), with no significant difference between the LL-BFR and HLT groups after 6 weeks (P > .05). However, at the end of 3 weeks, eversion muscle strength and Y-balance test scores were significantly higher in the LL-BFR group than in the HLT group (P < .05). Conclusions: Over 6 weeks, LL-BFR training was as effective as HLT in improving ankle muscle strength, muscle thickness, and balance in FAI patients, but LL-BFR training improved the ankle eversion muscle strength and dynamic balance more than HLT did in the early stages of the intervention. This finding will provide a new intervention strategy for the clinical rehabilitation of FAI patients. [ABSTRACT FROM AUTHOR]

Context: Posterior shoulder tightness evaluated as limited glenohumeral internal rotation and horizontal adduction is a risk factor for throwing-related shoulder and elbow injuries. Given that the throwing motion uses the entire body kinematics, limited lower-limb flexibility might be associated with posterior shoulder tightness. Therefore, we aimed to investigate the relationships between posterior shoulder tightness and lower-limb flexibility in college baseball players. Design: Cross-sectional study. Setting: University laboratory. Participants: Twenty-two college baseball players (20 right-handed and 2 left-handed). Methods: To investigate the relationships between glenohumeral range of motion and lower-limb flexibility using simple linear regression analysis, we measured passive range of motion of glenohumeral internal rotation and horizontal adduction, hip internal/external rotation in the prone/sitting position, ankle dorsiflexion, and quadriceps and hamstrings flexibility from both shoulders and legs. Results: Our analysis indicated that decreases in the lead leg hip external rotation in the prone position were moderately associated with limitations in glenohumeral internal rotation (R2 =.250, β [95% confidence interval, CI] = 0.500 [0.149 to 1.392], P =.018) and horizontal adduction (R2 =.200, β [95% CI] = 0.447 [0.051 to 1.499], P =.019) on the throwing shoulder. Furthermore, there were significant moderate relationships between decreases in glenohumeral internal rotation and limited lead leg quadriceps flexibility (R2 =.189, β [95% CI] = 0.435 [0.019 to 1.137], P =.022), and between decreases in glenohumeral horizontal adduction and limited stance leg ankle dorsiflexion (R2 =.243, β [95% CI] = 0.493 [0.139 to 1.438], P =.010). Conclusion: College baseball players with limited lower-limb flexibilities including the lead leg hip external rotation in the prone position, the lead leg quadriceps flexibility, and the stance leg ankle dorsiflexion showed excessive posterior shoulder tightness. The current results support the hypothesis that lower-limb flexibility is associated with posterior shoulder tightness in college baseball players. [ABSTRACT FROM AUTHOR]

Our study aimed to examine preoperative differences in strength and balance between dominant foot (DF) and nondominant foot (non-DF) of individuals undergoing ligament stabilization surgery in the general population. Patients with records of preoperative evaluation, including isokinetic dynamometric strength evaluation, Y-balance test (YBT), and Foot and Ankle Outcome Score (FAOS), were included in the study. The DF was the preferred leg for accurately kicking a ball through a goal. Statistical analysis determined the differences between DF and non-DF and the correlations between muscle strength, balance, and FAOS. There was no statistically significant difference between DF and non-DF regarding evertor and invertor muscle strength (p=0.082–0.951). The YBT revealed no significant difference between the two groups (p=0.082–0.951). There was a significant correlation between the evertor peak torque and total work deficits at 30°/s (p=0.022), as well as the evertor peak torque deficit at 120°/s (p=0.048). No significant differences in muscle strength and balance were found between DF and non-DF in nonathletes with chronic ankle instability. Peroneal muscle strength deficit was associated with functional impairment. Tailored interventions are needed to address limb dominance and muscle strength deficits in CAI management. [ABSTRACT FROM AUTHOR]

Background: Large spacers offer numerous advantages such as higher fusion rates and lower subsidence rates. However, due to the anatomical constraints of the approach, the use of large spacers in biportal endoscopic transforaminal lumbar interbody fusion(BE-TLIF) necessitates an additional incision and special instruments for spacer implantation leading to less frequent use. Methods: This study has refined several techniques within BE-TLIF. We insert the cage and impact the cage transverse with a special design instrument in the same working portal. This allows for the use of large spacers during BE-TLIF procedures without the need for an auxiliary cage-inserting incision. Conclusion: The technique is a straightforward, safe, and minimally invasive method for inserting large cages in the treatment of lumbar instability. [ABSTRACT FROM AUTHOR]

Introduction: Muscle fatigue, characterized by diminished force production and contraction sustainability, can impair muscle coordination and increase joint instability. Differing force profiles used in fatiguing tasks, such as prolonged eccentric trunk protocols, might provide insights into individualized strategies and resulting spinal stability. Thus, this study assessed individual differences in fatigue characteristics during an eccentric trunk flexion-extension protocol in a population of asymptomatic individuals. Methods: Twelve participants (2 f/10 m, 29 ± 4 years, 78.4 ± 16.9 kg, 1.76 ± 0.10 m) performed an eccentric trunk flexion and extension protocol on an isokinetic dynamometer (45° flexion to 10° extension; 60°/s), with final analysis on 8 participants for trunk flexion and 11 for trunk extension due to data exclusions. Participants engaged in a maximal all-out (AO) task for 2 min. Each participant's torque output (Nm) was assessed on a repetition-by-repetition basis, and smoothened by a moving average of 5 repetitions. Individual time profiles for reaching fatigue thresholds (10%, 15%, 20% and 30% reduction of initial torque output), and inter subject variability (by coefficient of variation, CV in %) were assessed throughout the AO task. Further, percentage torque reduction and variability were assessed at mid (1-minute) and end (2-minute) of task. Results: On average, for flexor and extensor muscles combined, participants reached a force reduction of 10% within 23.2 ± 19.1 s, of 15% within 44.9 ± 19.6 s, of 20% in 62.4 ± 26.3 s, and of 30% within 79.2 ± 21.8 s. The variability between individuals for the timepoint of reaching the defined torque thresholds was assessed by CV ranged between 23.4% and 103.8% for trunk flexor muscles, and between 28.4% and 56.5% for trunk extensor muscles. Discussion: A reduction of up to 20% was seen on average for all participants within 1-minute of eccentric trunk flexion and extension. Different inter-individual force output profiles were seen throughout the AO protocol, potentially related to physiological, skill-based, technical, adaptational, and/or motivational factors. The increase in fatigue resulted in a reduction in variability among individuals. A 2-minute protocol effectively induced pronounced fatigue, offering insights into individual force profiles and strategies. [ABSTRACT FROM AUTHOR]

Background: Functional Ankle Instability (FAI) is a pervasive condition that can emerge following inadequate management of lateral ankle sprains. It is hallmarked by chronic joint instability and a subsequent deterioration in physical performance. The modulation of motor patterns through attentional focus is a well-established concept in the realm of motor learning and performance optimization. However, the precise manner in which attentional focus can rehabilitate or refine movement patterns in individuals with FAI remains to be fully elucidated. Objective: The primary aim of this study was to evaluate the impact of attentional focus strategies on the biomechanics of single-leg drop landing movements among individuals with FAI. Methods: Eighteen males with unilateral FAI were recruited. Kinematic and kinetic data were collected using an infrared three-dimensional motion capture system and force plates. Participants performed single-leg drop landing tasks under no focus (baseline), internal focus (IF), and external focus (EF) conditions. Biomechanical characteristics, including joint angles, ground reaction forces, and leg stiffness, were assessed. A 2 × 3 [side (unstable and stable) × focus (baseline, IF, and EF)] Repeated Measures Analysis of Variance (RM-ANOVA) analyzed the effects of attentional focus on biomechanical variables in individuals with FAI. Results: No significant interaction effects were observed in this study. At peak vertical ground reaction force (vGRF), the knee flexion angle was significantly influenced by attentional focus, with a markedly greater angle under EF compared to IF (p < 0.001). Additionally, at peak vGRF, the ankle joint plantarflexion angle was significantly smaller with EF than with IF (p < 0.001). Significant main effects of focus were found for peak vGRF and the time to reach peak vGRF, with higher peak vGRF values observed under baseline and IF conditions compared to EF (p < 0.001). Participants reached peak vGRF more quickly under IF (p < 0.001). Leg Stiffness (kleg) was significantly higher under IF compared to EF (p = 0.001). Conclusion: IF enhances joint stability in FAI, whereas EF promotes a conservative landing strategy with increased knee flexion, dispersing impact and minimizing joint stress. Integrating these strategies into FAI rehabilitation programs can optimize lower limb biomechanics and reduce the risk of reinjury. [ABSTRACT FROM AUTHOR]

Background: Laterality and bilaterality have been reported as prognostic variables in developmental dysplasia of the hip (DDH) outcomes. However, there is little clarity across the literature on the reporting of laterality in developmental dysplasia of the hip (DDH) due to the variability in severity of the condition. It is widely accepted that the left hip is most frequently affected; however, the true incidence of unilateral left, unilateral right and bilateral cases can be hard to quantify and compare across studies. The purpose of this study was to examine laterality accounting for graded severity in a multi-centre, international prospective observational study of infants with hip dysplasia to demonstrate the complexity of this issue. Methods: A multi-centre, prospective hip dysplasia database was analyzed from 2010 to April 2015. Baseline diagnosis was used to classify patients into a graded laterality category accounting for hip status within the DDH spectrum. Results: A total of 496 patients were included in the analysis; 328 were <6 months old at diagnosis and 168 were between 6 and 18 months old. Of these patients, 421 had at least one frankly dislocated hip. Unilateral left hip dislocations were most common, with 223 patients, followed by unilateral right and bilateral dislocations with 106 and 92 respectively. Stratifying these patients based on status of the contralateral hip, 54 unilateral left and 31 unilateral right dislocated patients also had a dysplastic or unstable contralateral hip. There were significantly fewer bilateral patients in the 6 to 18-month group (p = 0.0005). When classifying laterality by affected hip, bilaterality became the predominant finding, comprising 42% of all patients. Conclusions: Findings from this multi-centre prospective study demonstrate the necessity to account for the graded severity in hip status when reporting DDH laterality. To accurately compare laterality across studies, a standardized, comprehensive classification should be established, as contralateral hip status may impact prognosis and treatment outcomes. Level of Evidence: Level II Prognostic Study. [ABSTRACT FROM AUTHOR]

Purpose: Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD) are understudied conditions characterized by hallmark hypermobility and chronic pain. Disease manifestations lead to significant disability. Understanding predictors of disability, over and above the univariate construct of pain severity, is necessary to tailor treatment. Thus, the current study examined the impact of the Fear-Avoidance Model [FAM] on disability in hEDS/HSD. Fear of falling was included as a novel fear-avoidance factor impacting disability. Methods: A total of 168 individuals with hEDS/HSD answered a cross-sectional online survey regarding FAM constructs, fear of falling, disability, and clinical-demographic factors. A hierarchical regression analysis was used to assess whether FAM constructs and fear of falling significantly predicted disability, over and above pain severity and age. Results: Pain catastrophizing, anxiety, and fear of falling contributed significant unique predictive relations, above age and average pain severity. Pain severity and fear of falling were the strongest unique predictors of disability. Conclusions: This is the first study to assess the relations among FAM constructs, pain severity, and disability in hEDS/HSD, and introduces fear of falling as a novel fear-avoidance factor specific to this population. Future research should apply these findings towards individualized interventions to improve disability in hEDS/HSD. IMPLICATIONS FOR REHABILITATION: Disability is significant in hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders, and may be predicted by psychosocial factors of anxiety, pain catastrophizing, and fear of falling. Our findings suggest that improving disability in hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders involves the consideration of physical factors, such as pain severity, along with psychosocial factors, the latter of which are amenable to change through individualized intervention plans. Fear of falling is a novel fear-avoidance construct that should be considered in future research and clinical settings to increase functionality in this frequently falling population. [ABSTRACT FROM AUTHOR]

Background Shoulder instabilities constitute a large proportion of shoulder injuries and have a wide range of presentations. While evidence regarding glenohumeral dislocations and associated risk factors has been reported, less is known regarding the full spectrum of instabilities and their risk factors. Purpose The purpose of this systematic review was to identify modifiable risk factors to guide patient management decisions with regards to implementation of interventions to prevent or reduce the risk of shoulder instability. Study Design Systematic Review Methods A systematic, computerized search of electronic databases (CINAHL, Cochrane, Embase, PubMed, SportDiscus, and Web of Science) was performed. Inclusion criteria were: (1) a diagnosis of shoulder instability (2) the statistical association of at least one risk factor was reported, (3) study designs appropriate for risk factors, (4) written in English, and (5) used an acceptable reference standard for diagnosed shoulder instability. Titles and abstracts were independently screened by at least two reviewers. All reviewers examined the quality studies using the Newcastle-Ottawa Scale (NOS). At least two reviewers independently extracted information and data regarding author, year, study population, study design, criterion standard, and strength of association statistics with risk factors. Results Male sex, participation in sport, hypermobility in males, and glenoid index demonstrated moderate to large risk associated with first time shoulder instability. Male sex, age <30 years, and history of glenohumeral instability with concomitant injury demonstrated moderate to large risk associated with recurrent shoulder instability. Conclusion There may be an opportunity for patient education in particular populations as to their increased risk for suffering shoulder instability, particularly in young males who appear to be at increased risk for recurrent shoulder instability. Level of Evidence Level III [ABSTRACT FROM AUTHOR]

The distal tibiofibular joint is described as a syndesmosis. The syndesmosis is important to the structural integrity of the ankle joint by maintaining the proximity of the tibia, fibula, and talus. Syndesmotic or high ankle sprains, involving the syndesmotic ligaments, pose a significant rehabilitative challenge due to their intricate anatomy, prolonged recovery periods following injury, and high susceptibility to persistent disability. Traditional management strategies have often been conservative, marked by lengthy periods of immobilization and a gradual return to activity. Severe syndesmotic injuries with diastasis have been treated surgically with screw fixation which may require a second intervention to remove the hardware and carries an inherent risk of breaking the screw during rehabilitation. Another fixation technique, the Tightrope™, has gained popularity in treating ankle syndesmosis injuries. The TightRope™ involves inserting Fiberwire® through the tibia and fibula, which allows for stabilization of the ankle mortise and normal range of motion. The accelerated rehabilitation protocol promotes early weight-bearing and has been shown to expedite the return to sport. This emerging strategy has shown promise in reducing recovery time as it is now possible to return to sport in less than 2 months after a tightrope repair and accelerated rehabilitation, compared with 3-6 months post screw fixation. This clinical commentary delves into this novel approach, highlighting the procedure, rehabilitation protocols, and the implications for physical therapy practice. [ABSTRACT FROM AUTHOR]

The ulnar collateral ligament (UCL) of the elbow plays a crucial role in elbow stability, specifically as a valgus and rotational constraint. Injuries to the UCL are common in overhead‐throwing athletes resulting in elbow instability. A timely diagnosis of early ulno‐humeral joint space widening in the overhead‐throwing athlete is required, to inform patient management and return to play. Sonographic assessment and measurement of the ulno‐humeral joint space with and without stress, and comparison to the contralateral uninjured side provides a quantitative assessment of instability. A systematic sonographic technique for single operator stress ultrasound is outlined to improve consistency of assessment and reporting of findings. [ABSTRACT FROM AUTHOR]

As total shoulder arthroplasty (TSA) expands to younger patients, it is crucial to weigh the benefits of early intervention against potential complications and implant longevity in patients under 60 years of age. This study examines mid-term outcomes in this patient subset. Between 2009 and 2019, a retrospective analysis was conducted on 50 patients (25 male, 25 female) who underwent anatomic TSA (TSA) under the age of 60 with minimum 5 years follow-up. Demographic and baseline variables were extracted from medical records. Pre-operative and post-operative outcomes of range of motion (ROM) and strength were recorded. Patient-reported outcomes (PROs) were obtained. Fifty patients were followed for an average of 8.7 ± 2.4 years, having a mean age of 54.1 ± 8.4 years. Comparison of pre-operative and post-operative measurements revealed significant improvements in active ROM, including external rotation (ER) (p < 0.0001), forward elevation (FE) (p < 0.0001), and internal rotation (IR) (p = 0.0001). There were significant improvements in functional strength scores, including ER (p = 0.0005) and FE (p = 0.0002). PROs included visual analog scale (VAS) (2.2 ± 2.6), Single Assessment Numeric Evaluation (SANE) (80.3 ± 17.6), American Shoulder and Elbow Surgeons (ASES) score (76.4 ± 22.8), and Simple Shoulder Test (SST) (8.9 ± 3.2). The 5-year and 10-year implant survival rates were found to be 98.0 % and 83.3 %, respectively. There were 7 postoperative complications in 5 patients (14.0 %), including glenoid loosening (n = 2), infection (n = 1), atraumatic instability (n = 1), lesser tuberosity avulsion (n = 1), painful arthroplasty (n = 1) and traumatic rotator cuff insufficiency (n = 1). Subsequently, all 5 patients underwent revision shoulder arthroplasty at an average of 6.5 years after the initial procedure. Positive mid to long-term outcomes, including significant improvements in ROM and strength, along with high 5-year and 10-year implant survival rates support TSA as an effective treatment option for patients under the age of 60. [ABSTRACT FROM AUTHOR]

Introduction: Ehlers–Danlos Syndrome (EDS) is a hereditary and heterogeneous syndrome that affects conjunctive tissue, due to collagen production compromise. Hypermobile EDS (hEDS) is the most common subtype of this syndrome and can cause shoulder joint instability, which can lead to chronic pain and significant functional impairment.Methods: A case report of a patient with hEDS followed in our local health unit was made. The authors describe their clinical insight regarding the case, as well as the rehabilitation program the patient was submitted to.Results: Female patient, 32 years old. Functionally autonomous in every daily living activity. Clinically diagnosed with hEDS in 2013, after reporting bilateral shoulder instability. The patient presented herself in a Physical and Rehabilitation Medicine consultation, 6 months after being submitted to the third surgical intervention of the right shoulder. She presented an overall limited range of motion, decreased muscle strength and positive apprehension and drawer tests. An extensive rehabilitation program was prescribed, focusing on joint mobilization, dynamic stabilizers strengthening and proprioceptive training. After 12 weeks, the patient presented reduced shoulder pain and a better functional status.Conclusion: hEDS compromises the integrity of the static and dynamic stabilizers of the shoulder. Clinical management of these cases involves a multidisciplinary approach with early and adequate rehabilitation care treatments. [ABSTRACT FROM AUTHOR]

Excessive muscle co-contraction is one of the factors related to the progression of knee osteoarthritis (OA). A previous study demonstrated that pain, joint instability, lateral thrust, weight, and lower extremity alignment were listed as factors affecting excessive co-contraction in knee OA. However, this study aimed to assess the association between fear-avoidance beliefs and muscle co-contraction during gait and stair climbing in people with knee OA. Twenty-four participants with knee OA participated in this cross-sectional study. Co-contraction ratios (CCRs) were used to calculate muscle co-contraction during walking and stair climbing, using surface electromyography. Fear-avoidance beliefs were assessed by the Tampa Scale for Kinesiophobia-11 (TSK-11) for kinesiophobia and the Pain Catastrophizing Scale (PCS) for pain catastrophizing. Secondary parameters that may influence co-contraction, such as degree of pain, lateral thrust, weight, and lower extremity alignment, were measured. The relationships between the CCR during each movement, TSK-11, and PSC were evaluated using Spearman's rank correlation coefficient and partial correlation analysis, adjusted by weight and lower extremity alignment. Partial correlation analysis showed a significant correlation only between medial muscles CCR and TSK-11 during stair descent (r = 0.54, p < 0.05). Our study revealed that kinesiophobia could be associated with co-contraction during stair descent in people with knee OA. [ABSTRACT FROM AUTHOR]

Background: One major goal of total knee arthroplasty (TKA) is to achieve balanced medial and lateral gaps in flexion and extension. While bone resections are planned by the surgeon, soft tissue laxity is largely intrinsic and patient-specific in the absence of additional soft tissue releases. We sought to determine the variability in soft tissue laxity in patients undergoing TKA. Methods: We retrospectively reviewed 113 patients undergoing TKA. Data on preoperative knee deformity were collected. Data from a dynamic intraoperative stress examination were collected by a robotic tracking system to quantify maximal medial and lateral opening in flexion (85–95 degrees) and extension (-5–20 degrees). T-tests were used to assess the differences between continuous variables. Results: A valgus stress opened the medial compartment a mean of 4.3 ± 2.3 mm (0.0–12.4 mm) in extension and 4.6 ± 2.3 mm (0.0–12.9 mm) in flexion. A varus stress opened the lateral compartment a mean of 5.4 ± 2.4 mm (0.3–12.6 mm) in extension and 6.2 ± 2.5 mm (0.0–13.4 mm) in flexion. The medial compartment of varus knees opened significantly more in response to valgus stress than valgus knees in both extension (5.2 mm vs. 2.6 mm; P < 0.0001) and flexion (5.4 mm vs 3.3 mm; P < 0.0001). The lateral compartment of valgus knees opened significantly more in response to varus stress than varus knees in both extension (6.7 mm vs. 4.8 mm; P < 0.0001) and flexion (7.4 mm vs. 5.8 mm; P = 0.0003). Conclusions: Soft tissue laxity is highly variable in patients undergoing TKA, contributing anywhere from 0–13 mm to the post-resection gap. Only a small part of this variability is predictable by preoperative deformity. These findings have implications for either measured-resection or gap-balancing techniques. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Tarsocrural osteochondrosis (OCD) is a developmental orthopedic disease commonly affecting young Standardbreds, with different fragment localization and size. Clinically, it is characterized by variable synovial effusion in the absence of lameness, whose determinants are ill-defined. We hypothesized that localization and physical characteristics of the osteochondral fragments like dimensions, multifragmentation, and instability influence joint effusion and correlate with synovial markers of cartilage degradation and inflammation. Clinical data, synovial fluid and intact osteochondral fragments were collected from 79 Standardbred horses, aged between 12 and 18  months, operated for tarsocrural OCD. The severity of tarsocrural joint effusion was assessed semiquantitatively. The osteochondral fragment site was defined radiographically at the distal intermediate ridge of the tibia (DIRT), medial malleolus (MM) of the tibia, and/or lateral trochlear ridge (LTR) of the talus. Size, stability, and arthroscopic appearance (unique or multi-fragmented aspect) of the fragments were determined intra-operatively. Synovial concentrations of C-terminal cross-linked telopeptides of type II collagen (CTX-II), leukotriene B4 (LTB4), and prostaglandin E2 (PGE2) were quantified. Tarsocrural synovial effusion was significantly affected by localization and stability of the fragments, with MMlocated and unstable fragments being associated with highest joint effusion. Concentrations of CTX-II, LTB4, and PGE2 positively correlated with the severity of synovial effusion. This study underlines characteristics of the osteochondral fragments determining higher synovial effusion in OCD-affected tarsocrural joints and suggests both inflammation and extra-cellular matrix degradation are active processes in OCD pathology. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare the functional outcomes, recurrence rate, range of motion (ROM) and return to sports activities between arthroscopic Bankart repair (ABR) versus arthroscopic Bankart/SLAP repair (ABR/S) in limited contact-athletes with a type V SLAP lesion in the scenario of recurrent anterior shoulder instability (RASI). Our hypothesis was that there is no difference between the two treatments. Methods: Two groups of 45 limited-contact athletes with type V SLAP lesion were created. Group 1 underwent an arthroscopic Bankart repair, while group 2 had an arthroscopic Bankart/SLAP repair. The minimum follow-up period was 2 years. The WOSI and ASES scores were used to assess primary functional outcomes. Recurrence rate, ROM and return to sport were also evaluated. Results: Significant differences were reported in the WOSI and ASES scores pre- and post-operatively in each group. There were no significant differences between the two groups (P = 0.78 and 0.43). We reported 4 recurrences (8.8 %) in group 1 and 5 (11.1 %) in group 2, with no difference between them (P = 0.62). There were no significant differences between the range of motion of each of the groups as well as between them. More than 90% of the athletes in both groups returned to their previous sporting activities. Conclusions: Limited-contact athletes with RASI who have a type V SLAP lesion as their primary diagnosis can be treated using either ABR or ABR/S with equal efficacy. Both treatment alternatives preserve athlete's function, stability, ROM and return to sport. [ABSTRACT FROM AUTHOR]

Purpose: Instability of the glenohumeral joint remains a complex clinical issue with high rates of surgical failure and significant morbidity. Advances in specific radiologic measurements involving the glenoid and the humerus have provided insight into glenohumeral pathology, which can be corrected surgically towards improving patient outcomes. The contributions of capsular pathology to ongoing instability remain unclear. The purpose of this study is to provide a systematic review of existing glenohumeral capsular measurement techniques published in the last 15 years. Methods: A systematic review of multiple databases was performed following PRISMA guidelines for all primary research articles between 2008 and 2023 with quantitative measurements of the glenohumeral capsule in patients with instability, including anterior, posterior and multi‐directional instability. Results: There were a total of 14 articles meeting the inclusion criteria. High variability in measurement methodology across studies was observed, including variable amounts of intra‐articular contrast, heterogeneity among magnetic resonance sequence acquisitions, differences in measurements performed and the specific approach taken to compute each measurement. Conclusion: There is a need for standardization of methods in the measurement of glenohumeral capsular pathology in the setting of glenohumeral instability to allow for cross‐study analysis. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Background: PTEN is primarily known as a tumour suppressor gene. However, research describes higher rates of difficulties including intellectual disability and difficulties relating to autism spectrum conditions (ASCs) in people with germline PTEN mutations. Other psychological characteristics/experiences are less often reported and are explored in this study. Methods: The parents of 20 children with PTEN mutations completed an online survey exploring adaptive behaviour, ASC‐associated behaviours, anxiety, mood, hypermobility, behaviours that challenge, sensory experiences, quality of life and parental wellbeing. Published normative data and data from groups of individuals with other genetic neurodevelopmental conditions were used to contextualise findings. Results: Overall levels of adaptive behaviour were below the 'typical' range, and no marked relative differences were noted between domains. Higher levels of ASC‐related difficulties, including sensory experiences, were found in comparison with 'typically developing' children, with a possible peak in restrictive/repetitive behaviour; ASC and sensory processing atypicality also strongly correlated with reported joint hypermobility. A relative preservation of social motivation was noted. Anxiety levels were found to be elevated overall (and to relate to sensory processing and joint hypermobility), with the exception of social anxiety, which was comparable with normative data. Self‐injurious behaviour was common. Conclusions: Results suggest a wide range of possible difficulties in children with PTEN mutations, including elevated anxiety. Despite elevated ASC phenomenology, social motivation may remain relatively strong. Firm conclusions are restricted by a small sample size and potential recruitment bias, and future research is required to further explore the relationships between such characteristics. [ABSTRACT FROM AUTHOR]

Background: Degenerative lumbar spinal stenosis (LSS) is a common condition that involves the narrowing of the spinal canal. Diagnosing instability traditionally requires standing lateral radiographs to detect dynamic translation, but there is debate about relying solely on radiographs due to challenges like patient discomfort and radiation exposure. This study aimed to evaluate if Magnetic Resonance Imaging (MRI) findings could effectively diagnose instability observed on radiographs. Methods: We reviewed 478 consecutive patients with degenerative LSS who had surgery at our institution. Instability was defined as a sagittal translation exceeding 3 mm on standing lateral radiographs in both extension and flexion. Patients were divided into stable (those with < 3 mm translation) and unstable groups (those with > 3 mm translation). The study assessed potential variables for instability, including MRI findings like facet joint effusion, facet joint angle, disk height index, intradiscal vacuum presence, endplate sclerosis, ligamentum flavum hypertrophy, and multifidus muscle fatty degeneration, comparing these factors between the two groups. Results: A total of 478 consecutive patients diagnosed with degenerative Lumbar Spinal Stenosis (LSS) were included. The average age of the patients was 66.32 years, with 43.3% being male. Approximately 27.6% of the cases exhibited signs of instability on the standing lateral radiograph during extension and flexion. The multivariate analysis using binary logistic regression revealed that facet joint effusion (odds ratio [OR] 2.73; 95% confidence interval [CI] 1.27–3.94; P = 0.002), disk height index (OR 2.22; 95% CI 1.68–3.35; P = 0.009), and the presence of the Vacuum sign (OR 1.77; 95% CI 1.32–2.84; P = 0.021) were identified as factors associated with instability. Conclusions: Our findings showed thata higher facet joint effusion, the presence of Vacuum sign, and a greater Disk Height Index were associated with the presence of instability on the standing lateral radiograph in extension and flexion in patients with degenerative LSS. [ABSTRACT FROM AUTHOR]

Individuals with chronic ankle instability (CAI) demonstrate altered movement patterns when their vision is disturbed during simple tasks, such as single-legged standing and walking. However, it remains unclear whether visual disruption by stroboscopic glasses alters movement patterns during landing-cutting movements, considered highly demanding sport maneuvers that mimic a typical athletic movement. To identify altered lower extremity kinematics and muscle activation when vision is disrupted by stroboscopic glasses during landing-cutting tasks in individuals with CAI. Case-control study. Laboratory. A total of 18 individuals with CAI (age = 22.3 ± 2.3 years, height = 1.75 ± 0.1 m, mass = 72.5 ± 9.8 kg) and 18 matched healthy controls (age = 21.7 ± 2.3 years, height = 1.75 ± 0.1 m, mass = 71.9 ± 10.3 kg). All participants performed 5 trials of a landing-cutting task with (SV) and without (NSV) stroboscopic glasses. Frontal- and sagittal-plane lower extremity kinematics and 6 lower extremity muscle activations during the stance phase of a landing-cutting task in the SV and NSV conditions. Individuals with CAI demonstrated more ankle-inversion angle from 18% to 22% and from 60% to 100% of the stance phase and more peroneus longus activation from initial contact to 18% of the stance phase under the SV condition than under the NSV condition. We observed no differences in knee- and hip-joint angles between the visual conditions for both groups. When wearing stroboscopic glasses, individuals with CAI showed altered movement patterns, including increased ankle-inversion angle and peroneus longus activation during the stance phase of a landing-cutting task. The results suggest that they may lack the ability to reweight sensory information to adapt their movement to visual disruption. [ABSTRACT FROM AUTHOR]

The study aimed to identify athlete-reported reasons for not returning to pre-injury sports level after anterior cruciate ligament reconstruction (ACLR) and to identify the factors associated with these reasons. Ninety-one athletes with 2 years post-ACLR indicated whether or not they had returned to their pre-injury sport level (same frequency, duration, and intensity). Athletes who did not return were asked to provide the reasons. Athletes' characteristics and injury-related factors were used to determine factors associated with the reasons for not returning. Only nine athletes (10%) returned to pre-injury sport level after ACLR. The most common reasons for not returning were lack of confidence or concerns about re-injury (48.8%), followed by continued post-surgical impairments in the reconstructed knee (39%). Having episodes of the knee giving way after ACLR was the only significant predictor of post-surgical impairments (48.8%; OR=8.3, 95%CI=2.48–27.42, p=0.001). Lack of confidence, concerns about re-injury, or post-surgical impairments in the reconstructed knee were the most frequently reported reasons for not returning to pre-injury sports level with 2 years post-ACLR. Reported dynamic knee instability was the only factor associated with ongoing post-surgical knee impairments after ACLR. Rehabilitation programs should address athletes' psychological responses and resolve knee impairments to optimize return to pre-injury sport level after ACLR. [ABSTRACT FROM AUTHOR]

Background: Generalized joint hypermobility as a characteristic feature of Ehlers–Danlos syndromes (EDS) is among the factors contributing to temporomandibular disorders (TMD). Objective: To evaluate the prevalence of TMD symptoms and their risk factors among women born in Sweden or Finland who were 27‐ to 78‐year‐olds with diagnosed hypermobile EDS (hEDS). Methods: A cohort of women with confirmed hEDS (n = 185) was constructed from the members of the National EDS Associations in both countries. Based on questionnaire data, frequency of independent variables in terms of socio‐demographic, general health and oral health‐related factors, comorbid symptoms and psychological distress for self‐reported TMD symptoms as the dependent variables, were calculated first. Prevalence ratios (PR) and their 95% confidence interval (95% CI) were estimated for the association between independent and dependent variables. Results: Nearly all participants reported TMD symptoms (98%) with TMD pain (95%), TMJ clicking (90%) and jaw fatigue (80%) as the most common symptoms and TMJ crepitation (63%) and luxation (44%) as the least common symptoms. Risk factors for TMD among 27‐ to 50‐year‐olds participants were Finland as a country of birth, living alone and self‐reported worst pain in the body (not the joints). The respective risk factors among the 51‐ to 78‐year‐olds were Finland as a country of birth, family history of EDS, tinnitus and regularly taking contraceptives. Conclusions: Among adult women with confirmed hEDS, socio‐demographic and health‐related factors and comorbid symptoms were significantly associated with TMD but with differences regarding age group. Therefore, management of TMD requires a multidisciplinary approach among the affected. [ABSTRACT FROM AUTHOR]

People who sustain joint injuries such as anterior cruciate ligament (ACL) rupture often develop post-traumatic osteoarthritis (PTOA). In human patients, ACL injuries are often treated with ACL reconstruction. However, it is still unclear how effective joint restabilization is for reducing the progression of PTOA. The goal of this study was to determine how surgical restabilization of a mouse knee joint following non-invasive ACL injury affects PTOA progression. In this study, 187 mice were subjected to non-invasive ACL injury or no injury. After injury, mice underwent restabilization surgery, sham surgery, or no surgery. Mice were then euthanized on day 14 or day 49 after injury/surgery. Functional analyses were performed at multiple time points to assess voluntary movement, gait, and pain. Knees were analyzed ex vivo with micro-computed tomography, RT-PCR, and whole-joint histology to assess articular cartilage degeneration, synovitis, and osteophyte formation. Both ACL injury and surgery resulted in loss of epiphyseal trabecular bone (−27–32%) and reduced voluntary movement at early time points. Joint restabilization successfully lowered OA score (−78% relative to injured at day 14, p < 0.0001), and synovitis scores (−37% relative to injured at day 14, p = 0.042), and diminished the formation of chondrophytes/osteophytes (−97% relative to injured at day 14, p < 0.001, −78% at day 49, p < 0.001). This study confirmed that surgical knee restabilization was effective at reducing articular cartilage degeneration and diminishing chondrophyte/osteophyte formation after ACL injury in mice, suggesting that these processes are largely driven by joint instability in this mouse model. However, restabilization was not able to mitigate the early inflammatory response and the loss of epiphyseal trabecular bone, indicating that these processes are independent of joint instability. [ABSTRACT FROM AUTHOR]

The elbow joint consists of the ulnohumeral joint, radiocapitellar joint and the proximal radio-ulnar joint. The osseous anatomy, static ligamentous restraints and dynamic stabilizers all contribute to maintain elbow stability. Elbow instability is a commonly encountered condition in clinical practice. There are several ways to classify elbow instability. Instability can be classified as simple or complex based on presence of an associated fracture, it could be classified based on mechanism of injury or it could be classified in a temporal fashion as acute or chronic. It is critical to understand injury patterns that can be treated non-operatively with physiotherapy and mobilization and the ones that need surgery. Surgical management of elbow instability could involve a combination of interventions addressing various ligaments like the lateral ulnar collateral ligament and medial collateral ligament; osseous structures including the radial head, coronoid and proximal ulna based on the mechanism and extent of injury. Adjunctive and salvage procedures may be necessary in delayed presentations or severe injuries. These include application of an internal joint stabilizer, external fixator, internal bracing of the ligament and bone grafting of the coronoid. The goal of treatment of instability is to provide an elbow that is stable and amenable to early active mobilization. [ABSTRACT FROM AUTHOR]

An increasing number of reports suggest an association between a newly recognized disease cluster and significant and often disabling gastrointestinal (GI) symptoms. This cluster is composed of diagnoses of hypermobility spectrum disorders (HSDs) such as joint hypermobility and hypermobile variant Ehlers-Danlos syndrome (hEDS), postural orthostatic tachycardia syndrome (POTS), and mast cell activation syndrome (MCAS). The diagnosis of these entities remains a challenge, as the pathophysiology of each has not been completely elucidated and the diagnostic criteria continue to evolve. This article describes a cohort of young adult females who shared similar GI symptoms, with intractable nausea and vomiting being most prominent and gastroesophageal reflux disease and constipation also occurring. Most strikingly, these females also exhibited or reported a history of HSD, hEDS, POTS, and/or MCAS. The clinical course of their GI symptoms was remarkable for considerable challenges in management, and artificial nutritional support proved necessary for some. This article describes the clinical features and outcomes of their GI manifestations, examines how these manifestations might be linked to their systemic syndromes, and discusses whether a shared pathophysiology exists. Pending the definition of a common thread between these conditions, this article seeks to raise awareness of their clinical definitions and foster research that will hopefully improve outcomes for these patients. [ABSTRACT FROM AUTHOR]

Simple Summary: Hip dysplasia is an orthoedic condition where the hip joint does not develop correctly which leads to pain and discomfort in the human and canine species. To better acknowledge this condition and find new treatment modalities, a model of hip dysplasia performed in rabbits by surgically modifying the hip joint was presented. A total of seventeen rabbits were used to assess morphological changes in the hip joint using radiography and computed tomography. Our research revealed that the surgery caused significant changes in the hip joint, making it similar to the hip dysplasia seen in dogs and humans. These changes included the increased rotation of the femur and a shallower acetabulum, which are key features of hip dysplasia. This rabbit model can be used to evaluate the progress of hip dysplasia and test new treatments, which may lead to better prevention and treatment options for hip dysplasia and the improvement of the quality of life for both animals and humans affected by this condition. The present study investigates the morphometric changes in the hip joint in a surgically induced rabbit model of hip dysplasia through the sectioning of the ligamentum capitis femoris and pelvic limb immobilization. A total of seventeen rabbits were evaluated using radiographic and computed tomographic imaging to measure the following parameters: the femoral angles of anteversion and inclination, length and width indexes of the neck of the femur, and acetabular depth and ventroversion. Significant differences in femoral anteversion angle and acetabular depth were observed, particularly in the group of hip instability surgery with pelvic limb immobilization. The results have shown the influence of hip joint instability in the promotion of femoral anteversion and acetabular shallowing. These findings provide a foundation for future research on naturally occurring or experimentally induced hip dysplasia in rabbits and underscore the model's potential for studying the biomechanical and developmental aspects of hip joint disorders. [ABSTRACT FROM AUTHOR]

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Hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD) are common causes of chronic musculoskeletal pain. Current practices rely on analgesics, physical therapy, bracing, and assistive devices. Dextrose prolotherapy (DPT) is a regenerative injection modality used to treat chronic painful musculoskeletal conditions through stimulation of tissue proliferation. The effectiveness of DPT for the treatment of chronic shoulder pain in patients with hEDS/HSD has not been established in the literature. Three patients with hEDS or HSD presented with refractory shoulder pain due to microinstability. Patients were treated with 20% DPT injected in the glenohumeral joint and surrounding structures as indicated. Outcomes assessed were pain and clinical improvement in joint stability at 2- to 7-week follow-up intervals. All patients reported subjective improvement in their shoulder pain and function. Disabilities of the Arm, Shoulder and Hand (DASH) scores after DPT decreased from initial assessment in all patients. Patients reported a cumulative improvement in pain and joint stability with each injection. Regenerative treatment with DPT may help restore structural integrity of affected joints and serve as an adjunctive therapy for the management of chronic shoulder pain due to microinstability in patients with hEDS/HSD. [ABSTRACT FROM AUTHOR]

Simple Summary: Spinal metastases can cause instability, making it difficult for clinicians to decide on the best treatment. While guidelines exist for stable and unstable spinal metastases, those with intermediate instability (a SINS of 7–12) pose a clinical challenge. This study examines risk factors that might require surgical intervention following initial radiotherapy in these patients. We analyzed data from 469 patients with spinal metastases treated between 2019 and 2021. Our findings show that patients with primary tumors in the lung, liver, or kidney, higher Bilsky grades of spinal cord compression, lytic bone lesions, and higher radiation doses are more likely to need surgery. These results suggest that the careful evaluation of these factors can help us to develop better treatment strategies for patients with intermediate spinal instability. Background: One important determinant in choosing a treatment modality is spinal instability. Clear management guidelines are suggested for stable and unstable spinal metastatic lesions, but lesions in the intermediate instability category (SINS [spinal instability neoplastic score] score of 7–12) remain a clinical dilemma. This study aims to analyze the risk factors necessitating surgical intervention after radiotherapy (RT) in patients with those lesions. Methods: A multicenter cohort of 469 patients with spinal metastases of intermediate instability who received radiotherapy (RT) as the initial treatment between 2019 and 2021 were retrospectively enrolled. All patients were neurologically intact at the time of RT. According to the performance of surgical intervention after RT, various clinical and radiographic risk factors for surgical intervention were compared between surgery and non-surgery groups using uni- and multivariate analyses. A recursive partitioning analysis (RPA) was performed using significant determinants identified in multivariate analysis. Results: The mean age at the time of RT was 59.9 years and there were 198 females. The lung was the most common primary site. During the mean follow-up duration of 18.2 months, surgical treatment was required in 79 (17.9%) of patients. The most common surgical method was decompressive laminectomy with stabilization (62.0%), followed by vertebrectomy with stabilization (22.8%) and stabilization only (15.2%). The mean SINS for the total cohort was 9.0. Multivariate regression analyses revealed that the primary tumor site of the lung, liver, and kidney, higher Bilsky grades of ESCC, lytic bone lesions, and higher EQD210 were significant risk factors for surgical intervention after RT. Among them, Bilsky grade, primary tumor type of the lung, liver, and kidney, and EQD210 were the most important determinants for expecting the probability of surgical intervention on RPA. Conclusions: Surgical intervention was performed in 17.9% of patients with intermediate instability after RT as the initial treatment. The primary tumor site of the lung, liver, and kidney, higher Bilsky grade of ESCC, and EQD210 were the most important determinants for expecting the probability of surgical intervention. Therefore, the optimal treatment strategy needs to be devised by carefully evaluating the risk of surgical intervention. [ABSTRACT FROM AUTHOR]

Background: After arthroscopic Bankart repair (ABR) for anterior glenohumeral instability (GHI), adolescent athletes have higher rates of subsequent recurrent GHI than any other subpopulation. Elucidating which adolescents are at highest risk of postoperative recurrent GHI may optimize surgical decision-making. Purpose: To identify prognostic factors associated with subsequent recurrent GHI requiring revision stabilization surgery (RSS) after ABR. Study Design: Case-control study; Level of evidence, 3. Methods: The study included patients 12 to 21 years old who had undergone ABR for anterior GHI at a pediatric tertiary care hospital by 1 of 5 sports medicine fellowship–trained surgeons between 2000 and 2020. A multivariate Cox proportional hazards model, with percentage of patients with recurrent GHI undergoing subsequent RSS, was used with a time-to-event outcome analysis. The Cox model effects were expressed as the hazard ratio (HR). All tests were 2-sided, with an alpha of.05. Results: Records of 488 adolescent patients with ABR (78% male; mean age, 16.9 ± 1.98 years) were analyzed. Of these, 86 patients (17.6%) underwent subsequent RSS for recurrent GHI, yielding a cumulative risk of 8.8% at 2 years, 16.5% at 5 years, and 20% at 15 years. RSS occurred at a mean of 2.6 ± 2.1 years after ABR. Risk factors for RSS included >1 preoperative dislocation (2 dislocations: HR = 7.4, P =.0003; ≥3 dislocations: HR = 10.9, P <.0001), presence of a Hill-Sachs lesion (small: HR = 2.5, P =.0114; medium-large: HR = 4.2, P =.0004), younger age (1-year decrease: HR = 1.2, P =.0015), and participation in contact sports (HR = 1.8, P =.01). Adolescents with only 1 preoperative dislocation had a cumulative incidence of RSS (3.2%), which was significantly lower than those with 2 (24.2%) or ≥3 preoperative dislocations (33.5%). Conclusion: The number of dislocations before index ABR was the strongest risk factor for recurrent GHI requiring RSS in adolescents with anterior GHI, with 2 dislocations conferring >7-fold increased risk compared with a single preoperative dislocation. Other significant risk factors included the presence of a Hill-Sachs lesion, younger age, and participation in contact sports. [ABSTRACT FROM AUTHOR]

Background: It remains unclear which subset of patients with recurrent patellofemoral instability would benefit from a concomitant bony realignment procedure in addition to a medial patellofemoral ligament (MPFL) reconstruction. Purpose: To provide midterm results for patients who underwent an isolated MPFL reconstruction as part of an ongoing prospective trial. Study Design: Case series; Level of evidence, 4. Methods: Patients with recurrent patellar instability were prospectively enrolled in an institutional registry beginning in March 2014. Exclusion criteria included history of a previous surgery for patellar instability, an off-loadable (inferior/lateral) chondral defect, anterior knee pain ≥50% of their chief complaint, and a "jumping J" sign. All patients underwent primary, unilateral, isolated MPFL reconstruction regardless of their bony anatomic characteristics. Patient-reported outcome measures (PROMs), episodes of recurrent instability, and ability to return to sport were obtained annually. Radiographic measurements of baseline radiographs and MRI were obtained at baseline. Results: A total of 138 patients underwent isolated MPFL reconstruction between March 2014 and December 2019. The mean radiographic measurements were tibial tubercle–trochlear groove, 15.1 ± 4.9 mm; Caton-Deschamps index, 1.14 ± 0.16; patellar trochlear index, 46.9% ± 15.1%; trochlear depth index, 2.5 ± 1.2 mm; tibial tubercle to lateral trochlear ridge, −8.4 ± 5.7 mm; and patellar tendon to lateral trochlear ridge, 5.7 ± 6.2 mm. Trochlear dysplasia, defined as a trochlear depth index <3 mm, was present in 79/125 (63%) patients. A total of 50 patients reached ≥5 years, of whom 40 (80%) completed follow-up PROMs. A total of 119 patients reached ≥2 years, of whom 89 (75%) completed follow-up PROMs. Six patients (5%) reported recurrent instability with a mean time of 2.97 years after surgery. All PROMs improved over time except for the Pediatric Functional Activity Brief Scale (Pedi-FABS), which had no change. At 2 years, the mean changes from baseline for Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life subscale (QOL), Pedi-FABS, International Knee Documentation Committee (IKDC) score, KOOS Physical Function Short Form (PS), and Kujala score were 42.1, 0.6, 35.1, –23.5, and 32.3, respectively. All changes had P values <.001 except for Pedi-FABS, which showed no change and had P >.999. At 5 years, the mean changes from baseline for KOOS-QOL, Pedi-FABS, IKDC, KOOS-PS, and Kujala score were 42.6, –2.8, 32.6, –21.5, and 31.6, respectively. All changes had P values <.001 except for Pedi-FABS, which showed no change and had P >.453. In total, 89% of patients returned to sport with a mean of 9.1 months. Conclusion: Midterm outcomes for patients who underwent isolated MPFL reconstruction were favorable and were maintained at 5 years. Outcomes for the expanded cohort of patients with a minimum 2-year follow-up support previously published results. [ABSTRACT FROM AUTHOR]

Background: Use of a rapid rehabilitation protocol for postoperative recovery after recurrent patellar dislocation (RPD) has gradually gained attention; nonetheless, evidence of its safety and effectiveness is lacking. Purpose: To compare the short-term postoperative outcomes of early rapid rehabilitation with those of conservative rehabilitation in patients with RPD. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 50 patients with RPD who underwent tibial tubercle osteotomy combined with medial patellofemoral ligament reconstruction were enrolled between January 2018 and February 2019. Postoperatively, the patients were randomly assigned to either the early rapid group (rapid group; n = 25 patients) or the conservative group (control group; n = 25 patients) for rehabilitation training. The rapid group underwent faster progression in weightbearing and range of motion (ROM) training. Knee joint functional scores, ROM, bilateral thigh circumference differences, and imaging data were recorded preoperatively and at 6 weeks and 3, 6, 12, and 24 months postoperatively for comparison. Postoperative complications were recorded over the 24-month follow-up period. Results: The baseline data did not significantly differ between the 2 groups. Postoperatively, compared with the control group, the rapid group had higher Tegner scores at 6 weeks and 3 months; higher Lysholm scores at 3 and 6 months; higher International Knee Documentation Committee scores at 6 weeks, 3 months, and 12 months; better ROM; and smaller bilateral thigh circumference differences at 24 months (P <.05 for all). However, no differences were observed in the Tegner, Lysholm, and International Knee Documentation Committee scores at 24 months postoperatively. At the 6-week and subsequent follow-up visits, the Caton and Insall indices were lower in the control group than in the rapid group (P <.01 for all). Moreover, compared with the control group, the rapid group had a lower incidence of patella baja at 24 months (0% vs 17%) and fewer complications during the whole follow-up period (P <.01). Conclusion: Early rapid postoperative rehabilitation appears to be safe and effective for patients who undergo tibial tubercle osteotomy combined with medial patellofemoral ligament reconstruction to treat RPD. In the short term, this approach was shown to be more advantageous than conservative rehabilitation in improving functional scores, allowing an earlier return to daily activities, although the lack of difference at 24 months implies no long-term benefits. In addition, it potentially helped to prevent the occurrence of complications, including patella baja. Registration: ChiCTR1800014648 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Futsal carries a high risk of injury for players. This systematic review aimed to assess the existing literature on injury prevention strategies for futsal players. The literature was searched using PubMed, Web of Science, and Scopus databases from inception to 20 March 2024. Relevant articles were searched using the terms "futsal" AND "injury" AND "prevention". Fourteen studies were included in the review. The review identified several injury prevention strategies with potential benefits for futsal players. Structured warm-up routines were shown to improve balance and eccentric strength and to reduce total, acute, and lower limb injuries. Proprioceptive training methods were suggested to improve joint stability and landing mechanics, which may reduce the risk of injury. Furthermore, multicomponent methods that include components such as core stability and flexibility have shown potential for reducing injury rates in futsal players. Finally, by reducing fatigue and improving movement control, strength training procedures designed to correct muscular imbalances may improve performance, which may ultimately minimize the risk of injury. This systematic review demonstrates the potential benefits of different injury prevention strategies for futsal players. The combination of several strategies, such as proprioceptive training, multicomponent programs, warm-up routines, and strength training specifically designed to address muscular imbalances, appears promising. [ABSTRACT FROM AUTHOR]