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Context: Ankle sprains are a common injury in sports, for which use of external ankle support during rehabilitation has been suggested to improve clinical outcomes. Design: Cohort study. Methods: Thirteen soccer players experiencing acute lateral ankle sprain injury were provided a novel adaptive ankle brace or conventional ankle taping (control) as external ankle support throughout the injury rehabilitation process. All other clinical procedures were identical, and rehabilitation was supervised by the same team staff member. Time from injury to clearance to return to sport was tracked. Player experience with the ankle brace also was queried via electronic surveys. Results: The median time to return to sport was less for the Brace group (52.5 d) compared to the Control group (79.5 d), but the distributions of the 2 groups were not found to differ significantly (P =.109). Player surveys indicated they felt the brace to be comfortable or very comfortable, with better freedom of movement than other braces and the same freedom of movement as wearing no brace. All players reported wearing the brace to be the same or better experience as ankle taping. Discussion: These preliminary results indicate that the adaptive ankle brace is at least as effective as ankle taping for providing external support during the rehabilitation phase following acute lateral ankle sprain and suggest it may be a more effective ankle support solution in terms of patient compliance than conventional bracing or taping. [ABSTRACT FROM AUTHOR]

Purpose: To explore how the change-point method can be used to analyze complex longitudinal data and detect when meaningful changes (change points) have occurred during rehabilitation. Method: This design is a prospective single-case observational study of a football player in a professional club who sustained an acute lower-limb muscle injury during high-speed running in training. The rehabilitation program was entirely completed in the football club under the supervision of the club's medical team. Four wellness metrics and 5 running-performance metrics were collected before the injury and until the player returned to play. Results: Data were collected over 130 days. In the univariate analysis, the change points for stress, sleep, mood, and soreness were located on days 30, 47, 50, and 50, respectively. The change points for total distance, acceleration, maximum speed, deceleration, and high-speed running were located on days 32, 34, 37, 41, and 41, respectively. The multivariate analysis resulted in a single change point for the wellness metrics and running-performance metrics, on days 50 and 67, respectively. Conclusions: The univariate approach provided information regarding the sequence and time point of the change points. The multivariate approach provided a common change point for multiple metrics, information that would benefit clinicians to have a broad overview of the changes in the rehabilitation process. Clinicians may consider the change-point method to integrate and visualize data from multiple sources to evaluate athletes' progression along the return-to-sport continuum. [ABSTRACT FROM AUTHOR]

Context: High secondary injury rates after orthopedic surgeries have motivated concern toward the construct validity of return-to-sport test batteries, as it is evident that common strength and functional assessments fail to elicit pertinent behaviors like visual search and reactive decision making. This study aimed to establish the test–retest reliability of 2 reactive agility tasks and evaluate the impact of visual perturbation on physical performance. Methods: Fourteen physically active individuals completed 2 agility tasks with reaction time (ie, 4 corner agility), working memory, and pathfinding (ie, color recall) components. Participants completed both tasks 4 times in 2 sessions scheduled 7 days apart. Outcomes included performance metrics of reaction time, time to target, number of targets, and total time assessed with reactive training timing gates. To assess test–retest reliability, we used intraclass correlation coefficients (ICCs), standard error of measurement (SEM), and minimal detectable change (MDC). Stroboscopic goggles induced visual perturbation during the fourth trial of each task. To assess the effect of visual perturbation, we used paired t tests and calculated performance costs. Results: The 4-corner agility task demonstrated excellent reliability with respect to reaction time (ICC3,1 =.907, SEM = 0.13, MDC = 0.35 s); time to light (ICC3,1 =.935, SEM = 0.07, MDC = 0.18 s); and number of lights (ICC3,1 =.800, SEM = 0.24, MDC = 0.66 lights). The color recall task demonstrated good-to-excellent test–retest reliability for time to lights (ICC3,1 =.818–.953, SEM = 0.07–0.27, MDC = 0.19–0.74 s); test time (ICC3,1 =.969, SEM = 5.43, MDC = 15.04 s); and errors (ICC3,1 =.882, SEM = 0.19, MDC = 0.53 errors). Visual perturbation resulted in increased time to target (P =.022–.011), number of targets (P =.039), and total test time (P =.013) representing moderate magnitude degradation of performance (d = 0.55–0.87, performance costs = 5%–12%). Conclusions: Both tasks demonstrated acceptable test–retest reliability. Performance degraded on both tasks with the presence of visual perturbation. These results suggest standardized reactive agility tasks are reliable and could be developed as components of dynamic RTS testing. [ABSTRACT FROM AUTHOR]

Assessment of player's postural control following a lower limb injury is of interest to sports medicine practitioners due to its fundamental role in daily tasks and sporting activities. The aim was to longitudinally monitor professional rugby union players' postural control during each phase of the rehabilitation program (acute, middle, and late) following a lower limb injury. Seven male rugby union players (height 1.80 [0.02] m; mass 100.3 [11.4] kg; age 24 [4] y) sustained a time loss, noncontact lower limb injury. Static postural control was assessed via sway path (in meters), and dynamic postural control was assessed via vertical postural stability index. Group differences (P <.05) were reported across the acute, middle, and late phase. Smaller magnitudes of sway path were observed for eyes-open sway path, and for the middle and late phase smaller magnitudes of vertical postural stability index (P <.05) at the end session compared with first session. Whereas larger magnitudes of vertical postural stability index were found between baseline and the last session (P <.05). Large interindividual and intraindividual variation was apparent across the 3 phases of rehabilitation. Postural control improvements were identified during rehabilitation. However, postural control did not return to baseline, with altered kinetics throughout each rehabilitation phase. [ABSTRACT FROM AUTHOR]

Background: Relative energy deficiency in sport (REDs) is a condition that is associated with negative health and performance outcomes in athletes. Insufficient energy intake relative to exercise energy expenditure, resulting in low energy availability, is the underlying cause, which triggers numerous adverse physiological consequences including several associated with musculoskeletal (MSK) health and neuromuscular performance. Purpose: This commentary aims to (1) discuss the health and performance implications of REDs on the skeletal and neuromuscular systems and (2) examine the role that MSK training (ie, strength and plyometric training) during treatment and return to performance following REDs might have on health and performance in athletes, with practical guidelines provided. Conclusions: REDs is associated with decreases in markers of bone health, lean body mass, maximal and explosive strength, and muscle work capacity. Restoration of optimal energy availability, mainly through an increase in energy intake, is the primary goal during the initial treatment of REDs with a return to performance managed by a multidisciplinary team of specialists. MSK training is an effective nonpharmacological component of treatment for REDs, which offers multiple long-term health and performance benefits, assuming the energy needs of athletes are met as part of their recovery. Supervised, prescribed, and gradually progressive MSK training should include a combination of resistance training and high-impact plyometric-based exercise to promote MSK adaptations, with an initial focus on achieving movement competency. Progressing MSK training exercises to higher intensities will have the greatest effects on bone health and strength performance in the long term. [ABSTRACT FROM AUTHOR]

Context: Osteitis pubis (OP), which occurs as a result of excessive use of the symphysis pubis and parasymphysis bones, is more common in long-distance runners and kicking athletes, especially football players. Due to the poor results of commonly used treatments for OP, there is a need for investigation of more effective treatments, such as ozone therapy. Ozone therapy is used to treat a variety of diseases, including musculoskeletal conditions. Case Presentation: A 30-year-old amateur soccer player diagnosed with OP received conservative treatment with traditional physiotherapy and analgesic medications. After 6 months and no resolution of symptoms, the patient presented to the sports medicine outpatient clinic seeking alternative therapy options. Management and Outcomes: The patient received ozone injections in 3 sessions administered at 10-day intervals. At 1, 3, 6 and 12 months after the treatment, the patient's complaints and pain levels were re-evaluated and examined. The patient was able to return to competition at the same level after the first injection. No recurrence was revealed at a minimum of 12 months of follow-up. Conclusion: In this article, we present a case in which OP was successfully treated with ozone injection. [ABSTRACT FROM AUTHOR]

Context : In March 2020, public health concerns resulted in school closure throughout the United States . The prolonged sport cessation may affect knee injury risk in high school athletes. The purpose of this study was to describe and compare risk of knee injuries in high school athletes during 2019-2020 and 2020-2021 academic years, and stratify by gender, severity, mechanism of injury, injury type, and knee anatomic region . Design : Historical-prospective cohort study . Methods : This historical- prospective cohort study included 176 schools in 6 states matched by sport participation in control and COVID years from July 1, 2019 to June 30,2021. Injury rates per 1000 athletes per year were calculated with 95% confidence intervals. A negative binomial regression was performed to assess potential differences in knee injuries between academic years . Results: 94, 847 and 72,521 high school athletes participated in the 2019-2020(19-20) and 2020-2021 (20-21) seasons. Knee injury risk was higher in the 20-21 season (19-20: 28.89% [27.82-29.96-]; 20-21: 33.82% [32.50-35.14]). Risk increased for male athletes from 2019- 2020 to 2020-2021 (19-20: 29.42% [28.01-30.83]; 20-21 : 40.32% [38.89-41.75]). Female knee injury risk was similar between years (19-20: 25.78% [24.29-27.27]; 20-21: 26.03% [24.31-27.75]). Knee injuries increased by a ratio of 1.2 ([95% CI, 1.1- 1.3], P <.001) during 2020-2021. Conclusions,· Knee injury risk and relative risk increased among males in 2020-2021. Results indicate changes in knee injury risk following return from COVID shelter in place among high school athletes and implicate potential negative downstream effects of interrupted sports training and participation on high school injury risk. [ABSTRACT FROM AUTHOR]

Context: Among many unanticipated changes, access to rehabilitation was disrupted during the onset of the COVID-19 pandemic. It is unclear how the timing of late-stage rehabilitation following anterior cruciate ligament with surgical reconstruction (ACLR) during the initial months of the pandemic affected outcomes. The purpose of this study was to compare physical performance outcome measures in patients following ACLR prior to and following COVID-19-related restrictions. Design: Retrospective cohort study. Methods: Data from patients who underwent return-to-sport testing following ACLR were analyzed based on date. December 2018 through March of 2020 (n = 66) was defined as the baseline period, and June through October 2020 (n = 27) was defined as the surveillance period. Outcome measures included single leg hop, triple hop, single leg vertical jump, and the lower-extremity functional test (LEFT). Linear mixed models were used to compare outcome measures before and after the onset of pandemic-related restrictions, clustered by sex and sport. A 1-way analysis of variance was performed to analyze the association between the number of virtual rehabilitation visits and outcome measures for subjects in the surveillance period. Results: Subjects in the surveillance period performed significantly worse in the LEFT (+7.88 s; 95% confidence interval, 1.11 to 14.66; P =.02) and single leg vertical jump on the unaffected side (−4.32 cm; 95% confidence interval, −7.44 to −1.19, P <.01), and performed better with single leg vertical jump symmetry (+6.3%; 95% confidence interval, 1.0% to 11.5%; P =.02). There were no other statistically significant differences. There was no significant association between having virtual rehabilitation visits and any of the performance outcomes. Conclusions: There was a decline in physical performance outcome measures in patients following ACLR who did not attend regular in-person physical therapy sessions in the late-stage rehabilitation due to COVID-19-related restrictions. Other factors during this unique time period, such as access to training facilities or psychosocial stressors, may have also influenced outcomes. [ABSTRACT FROM AUTHOR]

Context: With the high prevalence of anterior cruciate ligament rupture among young and active individuals, rehabilitation after the injury and surgery should meet the current evidence-based recommendations to restore knee function and reduce the risk of further injury. This study aimed to investigate the current rehabilitation practices and return to sports (RTS) criteria after anterior cruciate ligament reconstruction (ACLR) among physical therapists in Saudi Arabia. Design: Online cross-sectional survey-based study. Methods: A total of 177 physical therapists in Saudi Arabia participated in this survey. The survey included questions about the preferred postoperative timing and frequency of rehabilitation, current views on the importance of preoperative and postoperative rehabilitation to the overall outcomes, the timeframe of RTS, and the decision-making process to RTS. Results: Most therapists (96.6%) believed preoperative rehabilitation was essential/important to postoperative outcomes. Two-thirds encouraged patients to start rehabilitation program within 1 to 4 days immediately post-ACLR. RTS was permitted 6 to 9 months post-ACLR by 60% of therapists if satisfied with patient progress and capacity. Factors considered before RTS included knee strength (72.9%), functional capacity (86.4%), lower limb and trunk mechanics (62.7%), and psychological readiness (42.2%). Knee strength was assessed by manual muscle testing (39%), handheld dynamometry (15.3%), and isokinetic dynamometer (13.6%). While 60% of the therapists used single-limbed hop for distance for evaluating functional capacity, only 27.1% used a hop test battery. Conclusions: The surveyed physical therapists in Saudi Arabia demonstrated variations in the current rehabilitation practices and RTS criteria post-ACLR. Over half of the surveyed therapists considered preoperative rehabilitation essential to postoperative outcomes. However, the therapists should update their perspective with current evidence-based practice regarding the RTS timeframe, psychological readiness assessment for RTS, and knee strength evaluation using objective measurements. [ABSTRACT FROM AUTHOR]

Objective: To rate athletes' functional ability and return to sport (RTS) success at the end of their individual, formal, medically prescribed rehabilitation after anterior anterior cruciate ligament (ACL) reconstruction. Methods: In our prospective multicenter cohort study, 88 (42 females) adults aged 18-35 years after acute unilateral ACL rupture and subsequent hamstring grafting were included. All patients were prospectively monitored during their rehabilitation and RTS process until the end of their formal rehabilitation and RTS release. As outcome measures, functional hop and jump tests (front hop, balance hops, and drop jump screening test) and self-report outcomes (Knee Injury and Osteoarthritis Outcome Score, ACL-RTS after injury) were assessed. Literature-based cut-off values were selected to rate each performance as fulfilled or not. Results: At 7.5 months (SD 2.3 months) after surgery, the percentage of participants meeting the functional thresholds ranged from 4% (Knee Injury and Osteoarthritis Outcome Score SPORT) and over 44% (ACL-RTS after injury sum score) to 59% (Knee Injury and Osteoarthritis Outcome Score activities of all daily living) in the self-report and from 29% (Balance side hop) to 69% (normalized knee separation distance) in performance testing. Only 4% fulfilled all the cut-offs, while 45% returned to the same type and level of sport. Participants who successfully returned to their previous sport (type and level) were more likely to be "over-cut-off-performers." Conclusions: The low share of the athletes who fulfilled the functional RTS criteria highlights the importance of continuing the rehabilitation measures after the formal completion to assess the need for and success of, inter alia, secondary-preventive therapies. [ABSTRACT FROM AUTHOR]

The aim of the present study was to examine the effects of attention–deficit/hyperactivity disorder (ADHD) –related psychostimulant use in the context of concussion risk and symptom recovery. Data were obtained from the National Collegiate Athletic Association Department of Defense Grand Alliance Concussion Assessment, Research, and Education (NCAA-DOD CARE) Consortium from 2014 to 2017. Relative to individuals without diagnosed ADHD (i.e., control), both ADHD diagnosis and the combination of ADHD diagnosis and psychostimulant use were associated with a greater risk of incurring a concussive injury. Following a concussive injury, ADHD diagnosis was associated with longer symptom recovery time relative to the control group. However, individuals with ADHD who use psychostimulants did not take longer to resolve symptoms than controls, suggesting that psychostimulants may have a positive influence on recovery. Regardless of time point, ADHD diagnosis was associated with an elevated number of concussion-related symptoms; however, this effect appears mitigated by having used ADHD-related psychostimulants. [ABSTRACT FROM AUTHOR]

Athletic spaces are often perceived as unwelcoming by sexual minority (SM) athletes, contributing to disparities in sports persistence in early adulthood. Further examination of how SM navigate decisions about sports participation during the transition to college is needed to develop and maintain inclusive campus athletic offerings, including recreational sports. By analyzing interview data from 23 SM college students, we found that SM find supportive athletic community through important vetting of these spaces prior to initiation. SM look at two aspects of a program's makeup—its' values and visible diversity of its members—through one's own personal "vibe check" either in-person or online. SM men in particular look for gender "outsiders," as all-male spaces threaten their perceived safety. Among those who had previously dropped out of sports, finding mixed-gender teams through this vetting process provided promise for an eventual return to sport, highlighting the importance of recreational sports in engaging underrepresented groups of athletes. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has had serious implications on the health and well-being of student-athletes. The present study explored the athletic experiences of NCAA Division II college athletes during the competitive hiatus caused by the pandemic, as well as in their return to sport participation. Twenty male and female student-athletes from a variety of sports (freshman = 2, sophomores = 4, seniors = 9, and graduate = 5) participated in semistructured interviews to explore how the pandemic affected their athletic identity, anxiety, and mental health. Through the use of thematic content analysis, the following major themes were identified: (a) influence of COVID on athletic identity, (b) increased anxiety during COVID, (c) social aspects of sport participation, and (d) factors that influence mental health. Findings indicated a combination of positive and negative effects on the athletic identity, anxiety, and mental health and well-being of student-athletes. [ABSTRACT FROM AUTHOR]

Background: Only 55% of anterior cruciate ligament-reconstructed (ACLR) athletes return to competitive sports. This brings into question the usefulness of current return to sport (RTS) criteria. High cognitive demand of sport environment clarifies the value of incorporating neurocognitive tests when making decisions regarding the time of RTS. This preliminary study aimed to compare the neurocognitive functions between healthy controls and ACLR male athletes who passed or failed RTS criteria. Methods: A total of 45 male football players, including 15 ACLR who passed RTS criteria, 15 ACLR who did not pass, and 15 healthy controls participated in this cross-sectional study. The Cambridge Neuropsychological Test Automated Battery was used to measure a battery of neurocognitive tasks, including speed of response, sustained attention, working memory, cognitive flexibility, and response inhibition. Results: The results revealed that compared with both the ACLR-passed and healthy groups, the ACLR-failed group showed greater values of 5-choice movement time (P =.02, P =.01, respectively) but lower values of stop signal reaction time (P =.03, P =.001, respectively) and proportion of successful stops variables (P =.02). In addition, compared with the healthy group, both the ACLR-failed and ACLR-passed groups indicated greater values in between errors (P <.001, P =.008, respectively) and reaction latency variables (P =.002, P =.01, respectively) but lower values of A′ (P <.001, P =.007, respectively), probability of hit (P <.001, P =.03, respectively), and percent correct trials variables (P =.006, P =.02, respectively). Conclusions: Our findings indicated deficits in neurocognitive functions in ACLR male athletes. In addition, poor performance in sustained attention, working memory, and cognitive flexibility measures observed in the ACLR-passed group highlighted the necessity for using a multimodal approach via implementation of neurocognitive measures in conjunction with the functional and muscular assessments when making RTS decisions. [ABSTRACT FROM AUTHOR]

Background: Facilitating the healing process of injured anterior cruciate ligament (ACL) tissue is crucial for patients to safely return to sports. Stem cell derived exosomes have shown positive effects on enhancing the regeneration of injured tendons/ligaments. However, clinical application of exosomes in terms of storage and pre-assembly is challenging. We hypothesized that lyophilized exosomes derived from human umbilical cord stem cells (hUSC-EX) could enhance the cell activity of chronically injured ACL cells. Materials and methods: We harvested the 8 weeks injured ACL cells from rabbit under IACUC (No. 110232) approval. The studied exosomes were purified from the culture medium of human umbilical cord stem cells (IRB approval No. A202205014), lyophilized to store, and hydrated for use. We compared exosome treated cells with non-exosome treated cells (control group) from the same rabbits. We examined the cell viability, proliferation, migration capability and gene expression of type I and III collagen, TGFβ, VEGF, and tenogenesis in the 8 weeks injured ACL cells after hUSC-EX treatment. Results: After hydration, the average size of hUSC-EX was 84.5 ± 70.6 nm, and the cells tested positive for the Alix, TSG101, CD9, CD63, and CD81 proteins but negative for the α-Tubulin protein. After 24 h of treatment, hUSC-EX significantly improved the cell viability, proliferation and migration capability of 8 weeks injured ACL cells compared to that of no exosome treatment group. In addition, the expression of collagen synthesis, TGFβ, VEGF, and tenogenesis gene were all significantly increased in the 8 weeks injured ACL cells after 24 h hUSC-EX delivery. Discussion: Lyophilized exosomes are easily stored and readily usable after hydration, thereby preserving their characteristic properties. Treatment with lyophilized hUSC-EX improved the activity and gene expression of 8 weeks injured ACL cells. Conclusion: Lyophilized hUSC-EX preserve the characteristics of exosomes and can improve chronically injured (8 weeks) ACL cells. Lyophilized hUSC-EX could serve as effective and safe biomaterials that are ready to use at room temperature to enhance cell activity in patients with partial ACL tears and after remnant preservation ACL reconstruction. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to identify the type of veterinary care sought by handlers of injured agility dogs, the types of treatments the dogs received, and the timeframe for return to training and competition. Procedures: Owners of agility dogs completed an internet-based survey. They were instructed to report injuries that had kept the dog from training or competing for over a week, identify which area(s) of the body had been injured and answer questions about the most severe injury to each body part. Additional questions included if handlers had sought veterinary care, who primarily determined treatment, type of treatment(s), and length of time before the dog could return to full training and competition. Results: This sample included data on 1,714 total injuries from 1,256 unique dogs. Handlers sought veterinary care for over 80% of injuries across all anatomical locations. Handlers were most likely to seek specialty veterinary care for reported injuries to the stifle (71%), iliopsoas (63%) and tibia (61%), and least likely for reported injuries to the carpus (34%), metatarsus (33%) and metacarpus (22%). Treatment of reported injuries to the antebrachium and stifle were most likely to be directed by a veterinarian (>70%), while reported injuries of the thigh (51%) and hip (53%) were least likely. Rest was the most common treatment for all injuries. Return to sport within 3 months was common (>67%) for most perceived injury locations, though dogs with reported stifle injuries took longer to return to competition and had a higher rate of retirement. Conclusion and clinical relevance: Owners of agility dogs have a high rate of seeking veterinary care for injuries. Overall return to sport rates were high, with the stifle being the notable exception. Future studies regarding specific treatment of injuries in agility dogs, and how injuries and their treatment affect return to agility after injury are required to provide optimal care protocols for these canine athletes. [ABSTRACT FROM AUTHOR]

Background: UKA is a well-established treatment option for anteromedial osteoarthritis of the knee, resulting in superior functional outcomes but also higher revision rates than TKA. This study aimed to compare the outcomes of UKA, TKA, UKA converted to TKA using identical standard implants and revised TKA to support clinical decision-making. Methods: In this study, we retrospectively examined 116 patients who underwent UKA, 77 patients who received TKA, 28 patients whose UKA was converted to TKA using identical standard implants, and 21 patients who had a one-stage revision of TKA. The mean age at operation was 66.5 years (39–90 years), with a mean BMI of 28.8 kg/m2 (17.4–58.8) and a mean follow-up period of four years (0.9–9.9 years). We assessed various PROMs, including Oxford Knee Score, UCLA score, KSS score, and a modified WOMAC-Score as well as patient satisfaction and ability to resume daily activities, work, and sports. Results: The highest patient satisfaction was seen in the UKA. All scores were significantly higher for UKA than for TKA, converted UKA, and revised TKA. None of the scores showed a significant inferiority of converted UKA to TKA. In the case of revision, two scores showed significantly better results for converted UKA than for revised TKA. Conclusions: Our results indicated that patients initially treated with UKA did not have significantly worse functional outcomes after conversion to TKA, given the use of identical standard implants. This highlights the effectiveness of UKA as a therapeutic option with outcomes superior to those of primary TKA and the importance of a bone-sparing procedure. Conversely, revision TKA is linked to poorer functional outcomes compared to both primary arthroplasties. [ABSTRACT FROM AUTHOR]

A male, Division II collegiate football player presented with an extracondylar lateral patellar dislocation with inversion of the patella on its vertical axis following impact with the ground on the medial side. The patient was sedated for closed patellar reduction. He returned to full participation after 6 weeks of a progressive strength program. Extracondylar patellar inversion is not often associated with severe force or a direct blow, but the case described occurred after a high-impact tackle to the ground. This is also the only published case of a collegiate athlete returning to collision sport after sustaining an inverted extracondylar patellar dislocation. Despite the deformity and emergent nature of an inverted patellar dislocation, having patients complete early mobilization activities, including range of motion, and aggressive strengthening and functional progressions may facilitate a quick and safe return to highly intensive and competitive physical activity. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the mid‐term clinical outcomes for the non‐surgical and surgical management of acute proximal hamstring avulsions. Methods: Sixty physically active individuals were offered surgical or non‐surgical management for their proximal hamstring avulsion injuries. Distal retraction was defined as greater than 2 cm. Primary outcome measures were the Victorian Institute of sport assessment‐proximal hamstring tendons (VISA‐H) and functional assessment scale for acute hamstring injuries (FASH). Secondary outcome measures included palpable gap (cm), return to sport (RTS) and the ability to perform Nordic hamstring curls. Outcome variables were adjusted in regression models for gender, age, and treatment. Results: Thirty‐one patients elected to undertake non‐surgical management, and 29 chose surgery with a mean follow‐up of 34.8 ± 8.7 and 34.9 ± 7.0 months, respectively. The mean VISA‐H for the non‐surgical and surgical groups were 87.3 ± 3.4 and 87.9 ± 4.1 (n.s.), respectively. The mean FASH for the non‐surgical group was 89.3 ± 2.4 and 88 ± 3.6 for the surgical group (n.s.). This was consistent after adjusting for confounders. The mean gap for the non‐surgical group was 4.5 ± 1.09 and 4.9 ± 1.19 cm for the surgical group (n.s.). No significant differences were found in the abilities to perform Nordic hamstring curls (n.s.). Both groups achieved comparable RTS rates (n.s.). On average, the non‐surgical group achieved RTS at 5.5 ± 1.2 months post‐injury, whereas the surgical group was at 5.7 ± 0.7 months (n.s.). Conclusion: Physically active individuals with acute proximal hamstring avulsions and distal retraction of the tendon stump can be managed non‐surgically, achieving similar functional levels and RTS compared to patients treated surgically. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to study the effects of the severity of preoperative bone marrow oedema (BME) on the postoperative short‐term outcomes following bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLTs) and to propose a new metric that combines volume and signal density to evaluate BME. Methods: Sixty‐five patients with symptomatic OLTs (<100 mm2) and preoperative BME, who received BMS in our institution from April 2017 to July 2021 with follow‐ups of 3, 6 and 12 months, were analysed retrospectively. The area, volume and signal value of the BME were collected on preoperative magnetic resonance imaging. The enroled patients were divided into two groups according to the BME index (BMEI), which was defined as the product of oedema relative signal intensity and the relation of oedema volume to total talar volume. Visual analogue scale, American Orthopedic Foot and Ankle Society (AOFAS), Tegner, Foot and Ankle Ability Measure (FAAM)–activities of daily living (ADL) and Sports scores were assessed before surgery and at each follow‐up. The relationship between the scores and the volume, relative signal intensity and BMEI was explored. Results: Sixty‐five patients with preoperative BME were divided into the mild (n = 33) and severe (n = 32) groups based on the BMEI. A significant difference was found for each score with the general linear model for repeated measures through all follow‐up time points (p < 0.001). For the preoperative and 12‐month postoperative changes of the enroled patients, 53 patients (81.5%) exceeded the minimal clinically important difference of AOFAS and 26 (40.0%) exceeded that of FAAM‐sports in this study. The mild group showed significantly more improvement in AOFAS scores at 12 months (89.6 ± 7.0 vs. 86.2 ± 6.2) and FAAM‐ADL scores at 6 months (83.6 ± 7.6 vs. 79.7 ± 7.7) and 12 months (88.5 ± 8.5 vs. 84.4 ± 7.7) than the severe group (p < 0.05). No significant difference of all the scores between the groups was found at 3 months. No significant correlation was found in each group between BMEI and clinical outcomes. Conclusion: The severity of the preoperative BME negatively affected short‐term clinical outcomes following arthroscopic BMS for OLTs. Worse clinical outcomes were shown at postoperative 6 and 12 months in patients with a high preoperative BMEI, which could be a favourable parameter for assessing the severity of BME and assist in developing personalised rehabilitation plans and determining the approach and timing of surgery. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

With over 250 million players worldwide, soccer is the most popular sport in the world. The overall number of players at professional, amateur, and recreational levels has increased along with an increase in player diversity, including age and sex. These increases in player numbers, as well as a variety of demographics, have resulted in an increase in soccer-related injuries. injury in the professional setting can lead to time off the field and an effect on team results and earnings. injury at the amateur and recreational levels can lead to time off work, away from other activities, and change in activities of daily living. We provide an extensive list of common injuries sustained by soccer players, their pathophysiology, diagnosis, treatment, and general guidelines on return to play. [ABSTRACT FROM AUTHOR]

Soccer is considered the most popular sport in the world. The game involves frequent agile maneuvers, such as rapid accelerations/decelerations and pivoting, and carries an inherent risk of high-speed collisions, which can lead to lower extremity injury. Knee and meniscus injuries can cause significant pain and disability, precluding participation in the sport. Understanding the diagnosis and management of meniscal injuries in soccer players is essential to the care of these athletes. This paper reviews meniscal anatomy, biomechanics, and mechanisms of injury; discusses the work-up, diagnosis, and management of meniscus injuries; and reports on rehabilitation, return to sport, and outcomes after meniscal injuries in soccer players. [ABSTRACT FROM AUTHOR]

Groin injuries and femoroacetabular impingement are common among soccer players and can provide a challenge in diagnosis, as well as treatment. Nonoperative and operative measures are the 2 predominant treatments. This current review investigates the recent literature on groin and femoroacetabular impingement injuries in soccer players, as well as potential treatment modalities. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the awareness and knowledge of professional team sport athletes about ACL injuries, injury prevention programs, and the return to sports after ACL injuries. A total of 419 athletes representing soccer, basketball, volleyball and handball sports were included in the study. We utilized a 15-item self-report survey to assess the awareness of athletes about ACL injury, ACL injury prevention program, and return to sport after ACL injuries. Male and soccer players participated in prevention programs more than female athletes (p = 0.001). Participation in prevention programs was significantly higher in the ≥ 18 years old group than in the < 18 years old group (p = 0.040). Participants who were informed about ACL injuries were 8.4 times more likely to participate in the ACL injuries prevention program than others (OR: 8.38, 95% CI: 3.823–18.376, p < 0.001). The majority of participants believed that return to sport after ACL injury takes 6 months and 81.4% of them thought that it is not possible to do sport without an ACL. This study revealed that the awareness and performance of ACL prevention training programs among professional team sport athletes were insufficient. The athletes' knowledge regarding return to sports after ACL injuries was also inadequate. Improving athletes' knowledge of ACL injuries may lead to increased participation in ACL injury prevention programs. Thus, the provision of tailored educational interventions to athletes could potentially enhance their awareness and understanding of ACL injuries, consequently contributing towards the prevention of such injuries. [ABSTRACT FROM AUTHOR]

The aim was to present a descriptive 10-season summary of injury data from all teams of a professional football club using a heat map approach. Injuries and exposure time were registered according to the FIFA consensus in all men's and women's teams from Athletic Club over 10 seasons. A team-by-injury table was created, showing the incidence, median severity, and burden in each cell. Cells were coloured based on the injury burden value using a green – yellow–red gradient (lowest to highest). The highest overall injury burden was found in the women's 2nd and 1st teams and the men's U(under)17 team (>200 days lost/1000 h). Muscle injury burden demonstrated an increasing pattern with age. Knee joint/ligament injuries, particularly anterior cruciate ligament ruptures, had the highest impact on women's teams, followed by the men's 2nd team. In comparison, ankle joint/ligament injuries had a relatively low injury burden in most teams. Growth-related injuries were the most impactful injuries in the men's U15 and younger teams, and the women's U14 team. In conclusion, epidemiological data on injuries can inform and guide injury management processes. New and improved visualization methods might be important assets when presenting injury data to key decision-makers. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective chart review. Objective. To determine the effect of conservative measures on radiographic outcomes in those with isolated spondylolysis. Summary of Background Data. Spondylolysis is a common cause of low back pain in pediatric patients, affecting between 4.4% and 4.7% of all pediatric patients. This rate is even higher in high-level athletes, with recent studies suggesting a rate of 47% in this population. Conservative measures are recommended for treating symptomatic spondylolysis and are effective in controlling symptoms, but there is little evidence regarding their effect on radiographic outcomes. Methods. A retrospective review was conducted of patients diagnosed with spondylolysis who were treated at a single academic institution between January 1, 2012, and January 1, 2022. Data collected included demographics, presentation characteristics, pretreatment and post-treatment radiologic findings, types of treatments employed, and final symptomatic status at follow-up. The Student t test and the Wilcoxon rank sum test were used to compare continuous variables. The χ² test was used to compare categorical variables. Results. A total of 119 patients were included in the study. There was an 81.5% rate of healing on advanced imaging for those treated with conservative measures. When comparing those with healing on advanced imaging to those without, those with healing were more likely to have an acute fracture (P= 0.04), have symptomatic improvement (P<0.01), and return-to-play (P= 0.02) compared with those without. Those with healing also had an odds ratio of 6.9 (P< 0.01) and 4.5 (P=0.02) to achieve symptomatic improvement and return to their sport, respectively, compared with those who did not. Conclusion. Our study found those with isolated spondylolysis who were treated with conservative measures had a high healing rate on advanced imaging and those with healing had significantly higher odds of having symptomatic improvement and returning to play compared with those without. [ABSTRACT FROM AUTHOR]

Background Established norms for fitness and performance measures are lacking in circus arts. These would assist healthcare professionals and coaches to screen for readiness to participate in training or performance, determine post-injury return to performance, and develop targeted conditioning programs. Purpose The purpose of this research was to establish norms for trunk and extremity physical exam and performance measures in circus artists by professional status, assigned sex at birth (ASAB), and age. Study Design Descriptive laboratory study Methods Circus artists (n=201; ages 13-69y; 172 females ASAB, 29 males ASAB) from 10 cities across the United States underwent a baseline physical examination including shoulder, hip and trunk measures of passive (PROM) and active (AROM) range of motion, measures of flexibility (shoulder and hip), strength (manual muscle tests, grip strength), cardiovascular fitness (3 minute-step test), balance (single limb and handstand), and performance, (pull-ups, and the closed kinetic chain upper extremity stability test [CKCUEST]). ANOVAs were used to determine between group differences by age and T-tests to discern differences by ASAB or professional status. Results Differences existed by professional status for shoulder external rotation PROM, hip PROM, hip flexibility, shoulder and abdominal strength, and cardiovascular fitness. Sex differences were seen in active scapular upward rotation, hip and shoulder PROM and flexibility, hip and grip strength, and for functional performance measures (pull-ups, CKCUEST). Differences by age were limited to active scapular upward rotation, shoulder PROM, flexibility and strength, cardiovascular fitness, and balance. Overall, professionals outperformed pre-professionals for lower abdominal strength, pull-ups, handstand balance, cardiovascular fitness, hamstring, and straddle flexibility. Generally, males ASAB demonstrated greater shoulder flexibility and upper body functional strength while females ASAB had greater hip and lumbar flexibility and hip strength. No measures showed consistent declines with increasing age, though some showed differences between adolescents and adults. Conclusion These normative values for physical characteristics and functional performance in pre-professional and professional circus artists may be used to guide screening for readiness to participate in advanced training or performance, return to performance after injury, and the development of targeted strength and conditioning programs. Level of Evidence 3 [ABSTRACT FROM AUTHOR]

Background Functional performance tests (FPT) have been used with athletes following an injury to determine readiness to return-to-play (RTP), usually using limb symmetry indices to the contralateral limb or a baseline score. There is not a consensus as to which criterion scores are best compared. Hypothesis/Purpose This study aimed to compare common functional performance test scores from injured athletes at the time of release to RTP to both preseason baseline scores and to the contralateral limb. It was hypothesized that using baseline scores for comparison would be more responsive to residual deficits following injury than using the contralateral limb. Study Design Prospective longitudinal cohort study Methods High school athletes (n=395) from all varsity sports completed a battery of FPTs including the Y-Balance Test (YBT), single limb hop tests and T-Test for agility (TT) during their preseason to establish baseline data. Injured athletes (n=19) were re-tested using all FTP's again at the time of RTP. Paired t-tests were used to detect if significant (p<0.05) residual deficits were present at time of RTP when compared to baseline and to contralateral scores on FPTs. Results Differences in YBT scores were found in the anterior direction only (p=0.021) when comparing RTP to preseason, but there were no differences when compared to RTP data for the contralateral limb. Differences were detected with the single leg hop test (p = 0.001) when comparing the RTP to preseason and were also detected in both the single leg hop (p= 0.001) and triple hop (p=0.018) when compared to the contralateral limb. Differences in TT scores were detected when comparing RTP to preseason for cutting first with both the unaffected (p = 0.019) and affected (p = 0.014) limbs. Conclusions The YBT in the anterior direction and the TT are better able to detect residual deficits when comparing RTP to preseason scores. Hop tests are better able to detect deficits when compared to the contralateral limb. These results could make preseason testing more efficient when creating a reference for determining RTP readiness following lower extremity injury. [ABSTRACT FROM AUTHOR]

Background/Purpose Return to sport decision-making may be improved by assessing an athlete's ability to coordinate movement with opponents in sport. The purpose was to investigate whether previous injuries associated with female soccer players' interpersonal coordination during a collision avoidance task. The authors hypothesized that external perturbations would disrupt the strength and stability of coordinated movement, and that individuals with a history of injury would be less likely to recover coordinated movement. Study Design Cross-Sectional Methods Nine female athletes with a history of lower extremity injuries and nine without injuries were paired into dyads. Each dyad completed twenty trials of an externally paced collision-avoidance agility task with an unanticipated perturbation. Participant trajectories were digitized and analyzed using cross-recurrence quantification analysis (CRQA) to determine the strength and stability of interpersonal coordination dynamics. Trials in which participants with injury history assumed leader or follower roles within each dyad were then used to study how dyadic coordination varied across task stages (early, perturbation, and late) using linear mixed effect models. Cohen's d effect sizes were calculated to demonstrate magnitude of differences. In exploratory analysis, psychological readiness (i.e., self-reported knee functioning, fear of injury, and risk-taking propensity) was evaluated for their association with leader-follower status. Results Perturbation disrupted the strength (R2=0.65, p<0.001, early=49.7±1.7, perturbation=41.1±1.7, d=0.39) and stability (R2=0.71, p < 0.001, early=65.0±1.6, perturbation=58.0±1.7, d=0.38) of interpersonal coordination regardless of leader-follower status. Individuals with injury history failed to restore coordination after the perturbation compared to control participants (injury=44.2.0±2.1, control=50.8±2.6, d=0.39). Neither demographic nor psychological measures were associated with leader-follower roles (B=0.039, p=0.224). Conclusion Individuals with a history of lower extremity injury may have a diminished ability to adapt interpersonal coordination to perturbations, possibly contributing to a higher risk of re-injury. Level of Evidence 3 [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]

Anatomic total shoulder arthroplasty (TSA) remains the treatment of choice for primary glenohumeral osteoarthritis with an intact rotator cuff (PGHOA). However, reverse total shoulder arthroplasty (RSA) has gained popularity as a primary procedure in selected patients who may be at risk for postoperative rotator cuff dysfunction or glenoid loosening. The purpose of this study was to compare short-term outcomes between TSA and RSA in patients with PGHOA and limited preoperative forward flexion (FF). A retrospective review was performed on a multi-institutional registry of patients to identify patients aged less than 80 years undergoing TSA or RSA for PGHOA with preoperative FF ≤ 90°. Forty-five TSAs were identified and matched by age and sex to 45 patients undergoing RSA. A subset of 22 TSAs and 24 RSAs with severely limited preoperative FF of ≤ 70° was also analyzed. Range of motion including FF, external rotation and internal rotation, strength, and patient-reported outcomes including visual analog scale pain score, Western Ontario Osteoarthritis of the Shoulder index score, Veterans RAND 12 mental score, American Shoulder and Elbow Surgeons score, and Constant-Murley score were evaluated at a minimum of 2 years postoperative. No significant differences were observed in postoperative FF, external rotation, or strength measurements between groups. The limited FF TSA group achieved significantly improved internal rotation compared to the RSA group (L2 vs. L4, P <.002). No significant differences were observed between TSA and RSA in American Shoulder and Elbow Surgeons, visual analog scale, Constant, or Single Assessment Numeric Evaluation scores (P >.05) for both the overall comparison and subset of patients with FF of ≤ 70°. However, patients in the RSA cohort showed a significantly higher return to normal sporting activities than the TSA group. Patients aged less than 80 years with PGHOA and limited preoperative FF achieve similar postoperative range of motion and patient-reported outcomes whether treated with TSA or RSA. Therefore, limited preoperative FF does not appear to be a major determinant of outcomes for PGHOA. [ABSTRACT FROM AUTHOR]

Background: Lower extremity bone stress injuries (BSIs) are common among athletes who participate in high-impact activities. Conventional imaging is limited in assessing healing of BSIs. Hypothesis: Serial ultrasonography (US) can identify changes in appearance of lower extremity BSIs over time that can be correlated with symptoms and return to exercise/sport. Study Design: Cohort observational study. Level of Evidence: Level 3. Methods: Adults 18 to 50 years old with a recent exercise-associated BSI of distal tibia/fibula or metatarsals diagnosed by magnetic resonance imaging (MRI) were enrolled. US was performed every 2 weeks for 12 weeks. The sonographic appearance (soft tissue edema, periosteal reaction, hyperemia on power Doppler, callus) was correlated with the numerical rating scale (NRS) for pain and ability to return to sport/exercise. Results: A total of 30 patients were enrolled (mean age, 35.3 ± 7.7 years; 21 [70.0%] female). The tibia was most frequently affected (n = 15, 50.0%), followed by metatarsals (n = 14, 46.7%) and fibula (n = 1, 3.3%). At week 4, 25 of 30 (83.3%) had at least 1 US finding associated with the BSI. The degree of hyperemia was correlated with NRS at weeks 4 and 6 (Spearman correlations [ρ] 0.45 [0.09, 0.69] and 0.42 [0.07, 0.67], respectively), as well as return to sport/exercise at week 6 (ρ -0.45 [-0.68, -0.09]). US soft tissue edema was also correlated with NRS at week 6 (ρ 0.38 [0.02, 0.65]). Conclusion: Serial US of lower extremity BSIs can provide objective measures of healing. US findings were correlated with clinical outcomes at multiple timepoints. Clinical Relevance: US may have advantages over conventional imaging for monitoring healing of lower extremity BSIs. Further research is needed to better understand the prognostic value of these sonographic indicators of BSI healing and role in assessing readiness for return to sport/exercise. [ABSTRACT FROM AUTHOR]

Context: Muscle injury classification and grading systems have been reported for >100 years; yet it offer limited evidence relating the clinical or radiological qualities of a muscle injury to the pathology or clinical outcome. The British Athletics Muscle Injury Classification (BAMIC) incorporates recent predictive features of muscle injuries and provides a precise radiographic framework for clinical prediction and management. Objective: To investigate clinical outcomes, particularly time to return to play (RTP), reinjury rate (RIR), and prognostic value of specific magnetic resonance imaging (MRI) findings, of activity-related muscle injuries (tears) in athletes after application of the BAMIC. Data Sources: A search of PubMed (NLM), EMBASE (Ovid), Web of Science (Clarivate), Cochrane Library (Wiley), and ClinicalTrials.gov from the inception date of each database through August 31, 2022, was conducted. Keywords included the BAMIC. Study Selection: All English language studies evaluating clinical outcomes of RTP and RIR after activity-related muscle injuries and where BAMIC was applied were included. A total of 136 articles were identified, and 11 studies met inclusion criteria. Study Design: Systematic review (PROSPERO: CRD42022353801). Level of Evidence: Level 2. Data Extraction: Two reviewers independently screened studies for eligibility and extracted data. Methodological quality of included study was assessed independently by 2 reviewers with the Newcastle-Ottawa Quality Scale (NOS); 11 good quality studies (4 prospective cohort studies, 7 retrospective cohort studies) with 468 athletes (57 female) and 574 muscle injuries were included. Results: All studies reported a statistically significant relationship between BAMIC grade, BAMIC injury site, and/or combined BAMIC grade and injury site with RTP. A statistically significant increased RIR was reported by BAMIC grade and BAMIC injury site in 2 of 4 and 3 of 4 studies, respectively. The prognostic value of individual MRI criteria was limited. Conclusion: Consistent evidence suggests that BAMIC offers prognostic and therapeutic guidance for clinical outcomes, particularly RTP and RIR, after activity-related muscle injuries in athletes that may be superior to previous muscle injury classification and grading systems. [ABSTRACT FROM AUTHOR]

Background: Sacral stress fractures are a rare cause of low back pain in athletes. Given the low incidence of these fractures, there is a scarcity of data on symptomatology, risk factors, and clinical outcomes. Hypothesis: Patients diagnosed with sacral stress fractures would be athletes presenting with low back pain. Study Design: Case series of 13 patients with sacral stress fractures. Level of Evidence: Level 4. Methods: We conducted a retrospective review of medical records to identify patients diagnosed with sacral stress fractures at a single academic institution. Fractures were diagnosed on noncontrast T2-weighted magnetic resonance imaging scans and categorized using the Bakker classification system. Subjects were administered an electronic survey that asked about (1) the onset, time course, and location of pain and other symptoms; (2) time to treatment and treatment modalities pursued; (3) sports performance and time to return to sport; and (4) risk factors for stress fractures. Results: Of 18 eligible patients, 13 (72.2%) completed the survey with mean follow-up of 49.6 months (range, 1-144 months). Mean age was 28.0 years (range, 18-52 years); 9 patients (69.2%) were female, of whom 7 (77.8%) were premenopausal. The most common fracture type was Bakker type B (8 patients; 61.5%). Most patients presented with acute lumbosacral back pain in the setting of running/jogging activities. All patients underwent nonoperative treatment for an average of 3.8 months (range, 0-8 months) and three-quarters reported pain resolution at last follow-up. Rate of return to sport was 83.3%, but most patients reported ongoing deficits in running performance. Conclusion: Sacral stress fractures commonly present as acute lumbosacral back pain provoked by running sports. While the pain associated with these fractures prevents most athletes from participating in sports, nonoperative management appears to be an effective treatment modality with a high rate of return to sport. [ABSTRACT FROM AUTHOR]

Context: The limb symmetry index (LSI) is recommended as a milestone of return to play (RTP), and relying on the LSI value of a single-leg hop for distance (SLHD) test may overestimate rehabilitation status. Identifying a more reliable functional test can help to carefully make decisions for RTP. Objective: The aim was to compare the LSI value of the SLHD test with that of a single-leg vertical jump (SLVJ) test after anterior cruciate ligament reconstruction (ACLR) and determine which test provides lower LSI values. Data Sources: The PubMed, Web of Science, Embase, and Cochrane Library databases were searched from inception to July 2022. Study Selection: Observational studies with participants who had both SLHD and SLVJ tests after ACLR and LSI values of an SLHD and SLVJ were included. Disagreements were resolved after discussion between the 2 researchers. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 4. Data Extraction: Data on the primary outcomes (LSI values of the SLVJ and SLHD tests) were collected. Means and standard deviations (SDs) for each variable of interest were used to calculate standardized mean differences (SMDs). Results: A total of 12 studies met the inclusion criteria for the meta-analysis. A total of 587 patients underwent SLHD and SLVJ tests at different time points after ACLR. Compared with the SLHD test, the SLVJ test provided lower LSI values (SMD -0.42; 95% confidence interval (CI) -0.67 to -0.17). Subgroup analysis found that the SLVJ test provided a lower LSI value than the SLHD test in a specific period (approximately 7-18 months after ACLR, SMD -0.53; 95% CI -0.91 to -0.14) and a similar LSI value at other times. Conclusion: The SLVJ test provided lower LSI values in a specific period (7-18 months after ACLR). [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]

To assess the difference in perceived readiness to return to sport (RTS) within the first year postoperative period between individuals undergoing anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BTB) autografts or allografts. This was a prospective cohort study of patients undergoing primary ACL reconstruction done either with BTB autograft or allograft from 2010 to 2018. Skeletally mature patients aged 14 to 25 were eligible for inclusion. Patients completed the Marx Activity Rating Scale (MARS) questionnaire postoperatively evaluating perceived ability to perform various activities to compare subjective ability to RTS. Those patients who were outside outlined cohort age, failed to complete a single post-operative survey, underwent revision procedures, or underwent simultaneous or staged additional ligament surgery were excluded. Fifty-nine patients (20.1 ± 3.19 years, 57.6 % Male) were included in the study. Sixteen patients underwent ACL reconstruction with allograft (19.8 ± 3.43 years) while 43 patients received autograft (20.2 ± 3.13). At 3 months autograft recipients reported higher perceived ability to cut (P =.003). At 6-months, allograft recipients reported higher perceived ability to run (P =.033), cut (P =.048), and decelerate (P =.008) as well as a higher overall perceived ability to RTS (P =.032). At all other times, there was no significant difference between cohorts' subjective readiness to perform activities. The results of this study indicate that at times within the first year of recovery following ACL reconstruction, patients who receive allografts and autografts may have significantly different perceived ability to perform activities or RTS. However, while present at various times throughout the first year of recovery, any difference in perceived ability to perform activities or in overall RTS is no longer present at 12 months. Level II, Prospective cohort study. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence To assess the effect of preoperative and surgical factors on return to play (RTP) rates and career longevity of professional rugby athletes after primary anterior cruciate ligament (ACL) reconstruction (ACL‐R).A retrospective review of a consecutive cohort of professional rugby players undergoing primary ACL‐R by the senior author between 2005 and 2019 was undertaken. Athletes were included if they were under contract with a professional rugby team at the time of injury and had a minimum of 2‐year follow‐up. Univariate and multivariate analyses were performed to determine significant predictors of RTP rate, time and career longevity.One hundred and eighteen rugby players with 125 ACL‐Rs were identified. Return to professional rugby was achieved in 115/125 (92%) of cases at an average of 9.6 months and those athletes participated at the professional level for 5.9 ± 3.4 years after ACL‐R. Younger age (p = 0.006) and ACL‐R with a concomitant lateral extra‐articular tenodesis (LET) (p = 0.013) were predictors of a longer career. A Cox proportional hazards model that controlled for age revealed that athletes who underwent ACL‐R with an LET had increased career longevity compared to those with an ACL‐R without LET (hazard ratio = 2.74, p = 0.021). No factors were significantly associated with RTP rate or RTP time.In professional rugby players undergoing primary ACL‐R, those having ACL‐R with a concomitant LET and younger age predicted increased career longevity. Rugby players who underwent LET at the time of ACL‐R had an 18% greater chance of still playing professionally at 5 years compared to those who underwent ACL‐R alone.Level III. [ABSTRACT FROM AUTHOR]

Background: Distal triceps brachii tendon rupture (DTTR) is a relatively rare injury that is common in bodybuilding and high-intensity contact sports and can lead to significant functional impairment of the elbow joint. This study was conducted to evaluate clinical outcomes and the rate of return to sports among competitive bodybuilders and high-demand strength athletes after surgical repair of DTTR. Methods: This retrospective case series was performed in an institutional setting in tertiary health care. Return to sports of 22 competing or high-demand strength athletes (meaning three or more exercises per week) were analyzed pre- and postoperatively after surgical repair of DTTR using a hybrid technique of transosseous sutures and anchor fixation. Descriptive statistics were used to analyze demographic variables, and independent and paired t-tests were used to assess clinical outcomes. Results: The follow-up showed that from pre- to postoperatively, there was no deterioration in the number of sports disciplines (2.4 and 2.5 sporting activities per person, respectively; p = 0.540) or in the frequency of weekly training (4.1 and 4.1 times per person, respectively; p = 0.329). The postoperative visual analog scale for pain (from 6.0 to 1.6, p < 0.001), level of fitness (from 5.1 to 2.6, p = 0.002), and ability to train (from 5.2 to 1.3, p < 0.001) improved significantly. The time of return to sports was 1.5–3 months and 4–6 months after the surgery for ten patients each. The overall rate of return to sports was 95%, whereas 86% returned to the preinjury level of sporting activity. Conclusions: Repair of DTTR leads to high rates of return to sports in competitive athletes. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence This study aims to evaluate and compare patients' joint perception (PJP) with other commonly employed patient‐reported outcome measures (PROMs) in a cohort of patients following anterior cruciate ligament reconstruction (ACLR).A retrospective study was conducted on 108 patients who underwent ACLR between 2017 and 2021, with complete data available for visual analogue scale (VAS) pain, PJP, Forgotten Joint Score (FJS), Tegner Activity Scale, Lysholm Knee Scoring Scale, Anterior Cruciate Ligament Return to Sport After Injury (ACL‐RSI), Single Assessment Numeric Evaluation (SANE), Cincinnati Knee Rating System (CKRS) and The Hospital for Special Surgery Anterior Cruciate Ligament Satisfaction Survey (HSS ACL‐SS) at a mean follow‐up of 3 years. Spearman's rank‐order correlation was used to determine the correlations between clinical scores. A receiver operating characteristic (ROC) curve analysis was used to assess the discriminatory power of the chosen PROMs in detecting natural joint perception. Natural joint perception was defined as patients responding ‘like a native or natural joint’ or PJP = 1. This study hypothesized that PJP would demonstrate significant correlations with established PROMs, indicating its reliability and validity as a tool for assessing outcomes following ACLR.PJP showed significant correlations with all the reported PROMs, suggesting its potential as a valid and reliable assessment tool for evaluating ACLR outcomes. The ROC curve analysis indicated a good area under the curve for identifying natural joint perception using various PROMs. According to the PJP, nearly 20% of patients reported natural joint perception.This study evaluates PJP as a reliable tool for assessing patient outcomes following ACLR. Its significant correlation with other established PROMs underscores its potential as a valuable addition to the existing array of PROMs in ACLR.Level III. [ABSTRACT FROM AUTHOR]

This study investigates electromyography activation and force development differences in key lower limb muscles between female football players with previous anterior cruciate ligament injuries compared with healthy players. Twenty-two semi-professional players were divided into ACL-injured (n = 11) and non-injured groups (n = 11). Participants underwent maximal voluntary isometric contractions while electromyography activation, peak and average, and peak torque of force were measured. Results indicated significant differences in electromyography activation patterns between anterior cruciate ligament players and non-injured players, particularly in biceps femoris and gluteus maximus muscles. These differences were also evident when comparing between limbs within anterior cruciate ligament players. Interestingly, both groups exhibited similar peak torque of force during maximal contractions, suggesting a compensatory neuromuscular strategy that supports a return to sport based on kinetic and kinematic factors. However, these findings underscore persistent muscle integration imbalances potentially contributing to the high rate of anterior cruciate ligament reinjury. In conclusion, this study highlights the importance of evaluating electromyography activation alongside force development in understanding neuromuscular adaptations post anterior cruciate ligament injury. These insights emphasize the need for comprehensive rehabilitation strategies that address muscle imbalance to mitigate the risk of recurrent anterior cruciate ligament injuries in female football players. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence This study aims to perform a network meta‐analysis of hamstring graft preparation techniques to enhance anterior cruciate ligament (ACL) reconstruction guidelines and inform clinical decision‐making in patients with primary ACL rupture.A review of the literature, from 1 January 1990, to 31 August 2023, was conducted following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, focusing on the clinical outcomes of various hamstring graft preparation techniques. Forty‐six studies (over 4800 knees) were analysed. Eight graft compositions: doubled hamstring (ST/G)—1978 grafts, doubled hamstring with augmentation (ST/G+A)—586 grafts, tripled semitendinosus (3ST)—124 grafts, quadrupled semitendinosus (4ST)—1273 grafts, five‐strand tripled semitendinosus + doubled gracilis (3ST/2GR—839 grafts, six‐strand tripled semitendinosus + tripled gracilis (3ST/3GR)—335 grafts, seven‐strand quadrupled semitendinosus + tripled gracilis (4ST/3GR)—11 grafts and ≥eight strands—24 grafts were compared, considering graft sizes, laxity, muscle strength, range‐of‐motion, patient‐reported outcome measures (PROMs), return to sport (RTS) and adverse events.The 4ST grafts fared better than the ST/G grafts in the International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS) Sport, KOOS Q and RTS (mean difference [MD], −1.69; p = 0.0159; MD, −1.55; p = 0.0325; MD, −1.93; p = 0.001; odds ratio: 3.13; p < 0.0001). The IKDC differed significantly between the 4ST and ST/G+A groups (MD, 1.88; p = 0.046). The ST/G+A resulted in the lowest knee laxity, surpassing the ST/G, 3ST and 4ST. The ST/G had the smallest diameter (ST/G vs. ST/G+A: MD, 1.26; 95% confidence interval [CI]: 0.67–1.86, p < 0.0001). Reduced failure rates were noted with the 3ST/2GR (3ST/2GR vs. ST/G: MD, 6.93; p = 0.009) and 3ST/3GR (3ST/3GR vs. ST/G: MD, 53.64; p = 0.006).The ideal hamstring graft for ACLR should be individualized. A 4ST graft is likely to yield good PROMs. For high stability and rapid RTS, adding augmentation to the graft is advisable. The ST/G is the thinnest graft possible.Network meta‐analysis of level I–III studies. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusions Level of Evidence To investigate sex‐based recovery differences in patients undergoing anterior cruciate ligament reconstruction (ACLR) with a hamstring (HT) or quadriceps (QT) tendon autograft.This study included 97 patients, including 50 females (HT = 25, QT = 25) and 47 males (HT = 24, QT = 23), assessed presurgery and at 12‐ and 24‐month postoperatively via surveys, laxity, isokinetic knee extensor and flexor torque and a 6‐hop performance battery. Limb symmetry indices (LSIs) were calculated. Outcomes were compared between males and females, as well as within each graft type.Males reported significantly higher Tegner scores at 12 (p = 0.029) and 24 (p = 0.031) months, Anterior Cruciate Ligament Return to Sport after Injury scores at 12 (p = 0.009) and 24 (p = 0.010) months, and a significantly higher lateral hop LSI at 12 (p = 0.045) months, knee extensor torque LSI at 12 (p = 0.020) months, and knee flexor torque LSI at 12 (p = 0.001) and 24 (p = 0.039) months. Females undergoing ACLR with a QT (vs. HT) graft demonstrated a lower knee extensor torque LSI at 12 (p = 0.006) months, a lower lateral hop LSI at 12 (p = 0.038) months, and a lower medial hop LSI at 12 (p = 0.042) months.Females reported less activity and psychological readiness, as well as strength symmetry. Furthermore, the recovery of quadriceps strength and hop symmetry was delayed in females (vs. males) undergoing ACLR with a QT graft. A better understanding of these differences will assist in counselling on expectations, determining the most appropriate graft construct and permitting more targeted rehabilitation.Level IV. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusions Level of Evidence This study aimed to identify the risk factors for anterior knee pain (AKP) after medial patellofemoral ligament reconstruction (MPFLR).Patients aged 15–35 years who underwent isolated MPFLR between 2012 and 2022 were included in the study. These patients were divided into two groups (AKP and control group). Patient demographics and preoperative and postoperative clinical outcomes between the two groups were assessed and compared. Univariate logistic regression analysis was performed to explore the potential risk factors associated with postoperative AKP. Subgroup analysis stratified the results based on the time to return to sports (RTS) (>9 and ≤9 months). Furthermore, Spearman correlation analysis was performed to investigate the association between Kujala score and time to RTS.A total of 206 patients were included (AKP, n = 59; control, n = 147). At the 2‐year follow‐up, patients with AKP demonstrated a shorter duration in returning to their pre‐injury activity level compared to those without AKP (9.0 ± 3.6 vs. 10.3 ± 2.7 months, p < 0.05). RTS earlier than 9 months after MPFLR was the only significant risk factor associated with postoperative AKP (odds ratio, 2.13, 95% confidence interval, 1.03‐4.39; p < 0.05). Further subgroup analysis revealed that patient RTS earlier than 9 months exhibited worse patient‐reported outcomes in both the total cohort and control group (p < 0.05). Furthermore, among patient RTS within 9 months, a longer recovery duration before RTS strongly correlated with a higher Kujala score (R = 0.670, p < 0.001).Young patients who RTS at their pre‐injury levels before 9 months after MPFLR have a higher incidence of postoperative AKP and poorer functional outcomes compared to those who delay their return. Specifically, within the first 9 months after MPFLR, the earlier the RTS, the more severe the AKP symptoms. Careful consideration of the timing for RTS may help reduce the incidence of postoperative AKP.Level III. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence This study aimed (1) to determine complications and survival rates of lateral opening wedge distal femoral osteotomy (LOW‐DFO) in the long term, (2) to assess their clinical outcomes in the long term and (3) to identify risk factors of failure.Between 1991 and 2011, 62 LOW‐DFOs were performed in the same department. Inclusion criteria were all isolated LOW‐DFO performed for isolated lateral tibiofemoral osteoarthritis and valgus malalignment, with a minimum 10‐year follow‐up. Thirty‐eight patients were included, with a mean age of 48 ± 9 years. All patients had clinical and radiological assessments. The survival curves were calculated based on the following endpoints: unicompartmental or total knee arthroplasty.The mean follow‐up was 15.2 ± 4.4 [10–29] years. The mean preoperative mechanical FemoroTibial Axis (mFTA) was 188.8° ± 3.2° [184°–197°], primarily due to femur deformity (mean lateral distal femoral axis [LDFA] 83.2° ± 2.8°). Bone union was achieved in 89.5% of patients (n = 34) at a mean delay of 6.5 ± 6.7 months. The complication rate was 26% (five stiffness, one nonunion, three secondary displacements and one deep vein thrombosis). Nine revision surgeries (24%) were recorded. Survival rates at 5 and 10 years were 92.1% and 78.9%, respectively. The mean delay between DFO and total knee arthroplasty (TKA) was 11.6 ± 5.7 [1–27] years. Nineteen patients (50%) were free of TKA at the last follow‐up. KSS scores were improved significantly. Return to sports was obtained in 92% of cases (n = 35), with a mean delay of 11 ± 8 months. Seventy‐four per cent of patients were satisfied or very satisfied with the surgery. Eighty‐four per cent would be willing to undergo the surgery again. Older age (p = 0.032) was a significant risk factor for TKA conversion.LOW‐DFO is an efficient procedure to manage lateral knee osteoarthritis in young patients with valgus deformity, with a good survival rate at 10 years and high patient satisfaction.Level III. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusions Level of Evidence This study investigates the clinical and activity‐based outcomes after anterior cruciate ligament reconstruction (ACLR) versus multiligamentous knee reconstruction (MLKR) following a pivoting sports injury.Fifty MLKR patients were included, of which 20 (40%) were injured during pivoting sports. A further 50 patients undergoing ACLR following an injury during pivoting sports were consecutively recruited for comparison. Patients were assessed before the surgery and at 6‐, 12‐ and 24 months with patient‐reported outcome measures (PROMs) including the International Knee Documentation Committee (IKDC) form, Tegner activity scale (TAS) and anterior cruciate ligament return to sport after injury (ACL‐RSI) score. Knee movement, the single (SHD) and triple (THD) hop tests for distance, and peak isokinetic knee extensor and flexor strength were assessed, with Limb Symmetry Indices (LSIs) calculated. Outcomes were compared across groups: (1) ACLR (n = 50), (2) MLKR (n = 50) and (3) MLKR due to pivoting sport injury (n = 20).IKDC, TAS and ACL‐RSI scores remained lower (p < 0.05) in the full MLKR versus ACLR cohort at all timepoints. Comparing the ACLR and MLKR cohort that had injuries specifically during pivoting sports, the IKDC (p < 0.001) and TAS (p = 0.009) were higher in the ACLR group at 6 months, and the ACL‐RSI was higher at 6 (p < 0.001) and 12 (p = 0.007) months, there were no further differences. Hop and knee extensor strength LSIs were lower (p < 0.05) in the full MLKR (versus ACLR) cohort at all timepoints (apart from the 24‐month SHD LSI). However, the ACLR group only demonstrated greater LSIs than the pivoting sport MLKR for the SHD at 6 months (p < 0.001), and knee extensor strength at 6 (p < 0.001) and 12 (p < 0.001) months.While the recovery of patients undergoing MLKR due to a pivoting sports injury is delayed compared with their ACLR counterparts, the clinical outcome and activity profile are similar by 24 months.Level IV. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence To determine arthroscopic Bankart repair outcomes and recurrence risk factors at a minimum 5‐year follow‐up.Retrospective assessment of prospectively collected data, single‐cohort study of patients who underwent arthroscopic Bankart repair with a minimum 5‐year follow‐up. Demographical and preoperative instability features were collected. Primary outcome was recurrent instability set as dislocation or subluxation. Secondary outcomes were revision surgery, postoperative instability degree according to Manta criteria, objective and subjective clinical and functional status, assessed by the Rowe, Western Ontario Shoulder Index (WOSI) and Subjective Shoulder Value (SSV) scores. Return to sport and postoperative sports activity at the final follow‐up were also recorded.One‐hundred and seventy‐two patients, 82% men, average age at surgery 29.5 ± 9.2 years, were included. At a mean follow‐up of 8.3 ± 2.6 years, recurrent instability occurred in 53 of 172 patients (30.8%). Revision surgery was required in 23/53 (43.4%) of shoulder with recurrent instability. Recurrence occurred within the first 2 years postoperative in 49% of the shoulders, whereas 51% of recurrences occurred after this period. Recurrence took place after a traumatic event in 25% and 56%, respectively. Recurrence rates were higher in patients who underwent surgery after two or more dislocations (p = 0.029). Patients younger at the time of first dislocation, younger at surgery and those with a higher preoperative degree of instability also showed significantly higher rates of recurrence (p = 0.04, p = 0.02, p = 0.03). Postoperative ROWE, WOSI and SSV scores were significantly worse in patients with recurrent instability (p < 0.001). Return‐to‐sports rate was also lower in patients with postoperative recurrence (p < 0.001).The arthroscopic Bankart repair was associated with a high long‐term recurrence rate, and its effectiveness decreased over time. The lowest recurrence rates in arthroscopic Bankart repair were achieved in older patients with only one prior instability episode and a lower instability degree.Level IV. [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]

Background: The all-inside technique is now the most established treatment for meniscal repair, this usually involves a suture-based repair utilising interrupted sutures. A similar technique using continuous sutures can also be used; however there are no studies in the literature appraising this technique. This study aims to review outcomes for patients undergoing meniscal repair using a continuous suture all-inside technique. Methods: We reviewed patients undergoing meniscal repair using a continuous suture all-inside technique over a 5 year period. We recorded demographic details, injury type, surgical procedure, incidence of reoperation, functional outcomes (Tegner–Lysholm and International Knee Documentation Committee (IKDC) score) return to sport and failure of repair. Results: Data were collected for 37 patients. Mean age was 25.8 years, 81%, were male, median time to theatre was 169 days, mean follow-up time was 2.9 years. Concurrent ACL ruptures were present in 57%, all underwent ACL reconstruction in the same sitting. The mean Tegner–Lysholm score was 89. Mean IKDC score was 90.2. 78% were able to return to sport. Overall failure rate was 10.81%. Increasing age was associated with a decreased IKDC score (p = 0.02). Tegner–Lysholm score was significantly greater in patients with concurrent ACL injuries (p = 0.03) and patients with lateral meniscal tears (p = 0.04). Conclusion: In the first study to review outcomes following continuous all-inside suture-based meniscal repair we demonstrate excellent clinical outcomes with IKDC, Tegner–Lysholm, return to play and failure rates comparable to other commonly used techniques. We conclude that this is an acceptable and cost-effective technique. [ABSTRACT FROM AUTHOR]

Background: Snapping hip syndrome (SHS) is characterized by snapping sensation and pain and affects up to 10% of the general population. External snapping hip syndrome (ESHS), the most common form, is often due to repetitive movements in sports or anatomical predispositions. Conservative treatment includes physiotherapy and corticosteroid injections, while surgery is considered if conservative measures fail. Open surgical techniques carry several risks, while modern arthroscopic techniques offer less invasive options, such as endoscopic iliotibial band release (ITB) and gluteus maximus tenotomy. Materials and methods: A systematic review was conducted adhering to the PRISMA guidelines. Relevant studies were searched in four databases: Pubmed, Scopus, Embase, and Medline. The selected articles were evaluated according to the criteria of levels of evidence. The Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) was used to analyze the retrospective studies. This paper was registered in the International Prospective Registry of Systematic Reviews (PROSPERO). Results: Out of 9 included studies, 403 patients with 689 hips underwent endoscopic treatment. ITB release and his variations were the main surgical techniques. Gluteus maximus tenotomy was also used in some studies. Postoperative rehabilitation protocols varied. Patients generally experienced significant improvements in symptoms and functional outcomes, with low rates of recurrence (1.02%) and revision (0.15%). Complications were minimal. Conclusions: Endoscopic treatment of ESH shows favorable results, improving functional outcomes and returning patients to pre-injury activity levels. Long-term efficacy and costeffectiveness need to be evaluated, emphasizing the importance of large-scale prospective randomized trials to clarify surgery's benefits in refractory ESH cases. [ABSTRACT FROM AUTHOR]