Objective To describe the methodological characteristics and content of published hamstring muscle injury (HMI) rehabilitation programmes in order to inform clinical practice and guide future research.Methods We searched the MEDLINE (PubMed), Scopus and Web of Science electronic databases, on October 2024, using key terms “hamstring” and “rehabilitation”, with strategies refined after a preliminary search. Eligible studies included English-language publications involving non-surgically managed acute HMI in humans and reporting rehabilitation protocols.Results We included 137 articles. Primary research (43.1%, n=59) included mostly cohort and randomised controlled trials (RCTs); secondary research articles (54.0%, n=74) were predominantly narrative reviews. Overall, 54.7% of studies had a low level of evidence. Only 44.2% of primary research focused on HMI rehabilitation programmes of which 47.8% were RCTs. Rehabilitation programme details were often missing. In the subacute/functional phases, strengthening (78.3%) and stretching (55.6%) were most frequently reported. Return-to-sport criteria were reported in only 43.5% of primary research, often based on pain resolution. Across both primary and secondary research, 40 different rehabilitation strategies were identified, with the most frequently reported being eccentric-based strengthening, flexibility exercises, progressive running and agility protocols. Key gaps included lack of standardisation, under-reporting of programme parameters and limited inclusion of diverse sporting populations.Conclusions Current scientific literature on HMI rehabilitation programmes shows wide variety, limited high-level evidence primary research and under-reporting of key clinical details. More rigorous and inclusive studies are needed to improve the standardisation and clinical applicability of rehabilitation strategies.
Objectives:To map and summarise the existing scientific literature on on-field rehabilitation (OFR) exercises, progression and principles supporting athletes' return to contact team sports after anterior cruciate ligament (ACL) injury. Design:Scoping review. Data sources:PubMed, CINAHL, AMED, Cochrane, SPORTDiscus, PEDro, Scopus and Embase Library were searched in April 2025. Eligibility criteria for selecting studies:Sources of any design published between 2010 and 2025 that described or evaluated OFR for athletes returning to contact team sports after ACL injury or reconstruction, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines; studies involving athletes of any age, sex or competition level were eligible. Results:The search identified 6880 records; 38 sources met the inclusion criteria. Most sources were descriptive and focused predominantly on football, with limited representation of basketball, rugby and ice hockey. OFR was commonly described using multistage (2-5 steps) frameworks progressing from linear running and controlled drills to multidirectional movements, sport-specific skills and practice simulations. Progression was primarily criterion-based rather than time-based, guided by minimal pain or swelling, restored knee range of motion, adequate strength and limb symmetry, and tolerance to running loads. Several articles applied the control-chaos continuum. Collaboration between physiotherapists, coaches and athletes was emphasised, although roles, responsibilities and organisational structures were rarely described. Conclusion:The current OFR literature after ACL injury is largely descriptive, emphasising staged, criterion-based progression and multidisciplinary collaboration. However, actionable guidance on roles, responsibilities and organisational structures is minimal, underscoring the need for empirical studies to establish and evaluate standardised OFR practices. Trial registration number:10.17605/OSF.IO/T6UN2.
Objectives Around 80% of children/adolescents globally do not meet recommended levels of physical activity (PA). The 2020 WHO consensus updated PA guidelines, changing from ‘60 minutes of PA/day’ to at least ‘an average of 60 min/day’. This means that attaining 420 min/week expresses the minimum threshold for PA. This analysis examined the effects of the changed guidelines on children/adolescents meeting PA guidelines. A coprimary research question examines single-item PA questions to determine the number of days of 60 min of activity that best reflect meeting the new PA guideline. Methods Data were from five population-level Australian and New Zealand surveys (two representative population surveillance datasets and three large community interventions). PA questions included the single item question (days/week of 60 min) and detailed PA measures including International Physical Activity Questionnaire-adolescent questions. The single-item analysis used receiver operating characteristic (ROC) curves to identify the best fit between the single-item and more extensive PA measures (maximising sensitivity and specificity). Results The proportion meeting the old PA guidelines ranged from 28–55%, compared with 35–84% meeting the new guideline (average absolute increase of 26.2%). ROC analysis described areas under the ROC curve between 0.728 and 0.907. The best fit (Youden’s Index >0.5) was 4–5 days/week where the single item best classified children and adolescents meeting the new guideline. Conclusions The new guideline classified 26% more children and adolescents meeting updated PA guidelines. National research reports should use updated PA guideline criteria, and for surveillance, 4–5 reported days/week on the single PA question best estimates meeting the PA guideline threshold.
Background/objectives During adolescence, parents and guardians can play an important role in shaping their child’s attitudes, beliefs and behaviours. Yet research examining their beliefs and behaviours regarding injury and prevention within adolescent female rugby union is limited. The primary aim of the study was to identify attitudes, beliefs and behaviours towards injury and injury prevention among parents and guardians of adolescent female rugby players, including subgroup differences. The second aim was to examine how attitudes and beliefs aligned among parents and guardians and the players (their child). Methods Parents and guardians of adolescent female rugby players were recruited from under-16 and under-18 rugby schools/colleges, clubs, and regional talent pathways teams and asked to complete an online cross-sectional survey. Results Two hundred and eighty-five parents and guardians responded to the survey; 144 parents and guardians and players (their child) completed their respective surveys. Fifty-four per cent believed it was ‘possible to prevent some rugby injuries’. Understanding of equipment effectiveness varied; 12% agreed that wearing a scrum cap could prevent concussions. Agreement between parent and guardian and player responses to statements regarding injury and injury prevention varied; Gwet’s AC ranged from almost perfect agreement (0.8–1) to fair agreement (0.21–0.4). Conclusion The study advances understanding of parents’ and guardians’ attitudes, beliefs and behaviours regarding injury and injury prevention in adolescent female rugby, showing generally safe practices while highlighting notable gaps that constrain effective injury management. Addressing these gaps offers a practical route to improving the consistency of parents’ and guardians’ safeguarding players’ welfare.
Objectives The aim of this study was to determine temporal trends in sports and exercise participation frequency among European Union adults. Methods We analysed Eurobarometer survey data collected among 96 948 adults from 26 European Union countries in 2009, 2013, 2017 and 2022. Self-reported frequency of sports and exercise participation was categorised as: ‘never’, ‘less than once a month’, ‘monthly’ (1–3 times per month) and ‘weekly’ (at least once a week). Multilevel ordinal logistic regression was used to analyse trends in sports and exercise participation frequency for the overall sample and by gender, age, marital status, employment, place of residence, number of household members and country. Results The prevalence of no participation in sports and exercise increased from 41.7% (95% confidence interval [CI] 40.6% to 42.7%) in 2009 to 45.8% (95% CI 44.8% to 46.8%) in 2022. The frequency of sports and exercise participation decreased from 2009 (reference year) to 2017 (adjusted odds ratio [OR] for 2013=0.96; 95% CI 0.92 to 0.99; OR for 2017=0.87; 95% CI 0.84 to 0.91) and then increased in 2022 (OR=0.92; 95% CI 0.89 to 0.95), suggesting a U-shaped trend (p<0.001). The most concerning trends were found for females, middle-aged adults, those living alone, Denmark, Hungary, Poland, Portugal and Sweden. Conclusion The persistently high prevalence of no sports participation highlights the need to strengthen the promotion of sports and exercise in the European Union. The focus should be on the population groups and countries with declining frequency of sports and exercise participation.
Objectives To reduce injury burden among police recruits we must identify who is responsible for implementing prevention strategies. Using a novel methodology, we aimed to examine the perspectives of police force recruits and staff to determine who they perceived to be responsible to implement important injury prevention strategies.Methods We performed a cross-sectional study co-designed by our broader consumer, industry and research advisory groups. Five data collection sessions were conducted, involving a total of nine separate groups; analyses were performed by group rather than at the individual level. Groups were clustered by organisational role: management (n=2 groups), training delivery (n=3 groups) and recruits (n=4 groups). Participants allocated 57 previously identified important injury prevention strategies to the group(s) ((1) recruits, (2) training delivery, (3) management) responsible for implementing each strategy.Results Participants identified almost three-quarters of prevention strategies required shared responsibility among recruits, training delivery staff and/or management. No strategies were considered the sole responsibility of recruits.Conclusion Our research demonstrated that while recruits must take ownership and responsibility for some aspects of their training no prevention priority areas are the sole responsibility of recruits. Thus, recruit injury prevention must be implemented by recruits, training delivery staff and management.
Objective To describe and evaluate the implementation and outcomes of a targeted health professions education (HPE) programme. Aspetar Orthopaedic Sports Medicine Hospital’s accredited education programme targets a global health professions audience—those working at the hospital, those employed to provide services at all Qatar’s sports clubs and federations and those from the region and globally. Design A descriptive process evaluation using routinely collected survey data from accredited continuing professional development (CPD) activities in Aspetar between 2017 and 2023. The evaluation was structured by the RE-AIM framework which evaluates a program across the five dimensions: Reach, Effectiveness, Adoption, Implementation, and Maintenance. Results During the study period, 420 accredited CPD activities were completed and attended by 50 772 professionals. A total of 13 557 feedback survey responses were collected during the first accreditation cycle of the HPE programme (2017–2023). The HPE programme demonstrated a steady increase in reach over time, received positive effectiveness ratings and demonstrated a steady increase in attendance rate highlighting successful implementation. Conclusion Applying the RE-AIM framework highlighted key strengths in the reach, effectiveness and implementation of the Aspetar HPE programme. Overall reach was satisfactory; effectiveness was evident through perceived improvement in clinical performance and implementation through continuous learning over time. Although not all framework dimensions were applicable to our study, our findings could inform efforts to further improve the HPE programme, serve as a model for similar education programmes elsewhere and bolster healthcare services and patient outcomes in sports medicine.
Background Regular menstruation is an important indicator of well-being in adolescent females. We aimed to assess risk factors associated with menstrual cycle irregularities in a population-based cohort of high school students.Methods In the fall of 2022, we recruited a cohort of 1161 first-year female students from 21 socio-economically diverse high schools in the capital region of Finland. Participants completed an online survey addressing menstruation, academic performance and sports participation and validated questionnaires (the Sick-Control-One stone-Fat-Food (SCOFF) eating disorder screening tool and School Burnout Inventory).Results Of 935 (81%) participants (mean age 16) not using hormonal preparations, 336 (37%) reported irregular menstruation. Elevated School Burnout Inventory scores (per point OR 1.03, 95% CI 1.01 to 1.05), lower body mass index (OR 1.86, 95% CI 1.12 to 3.08) and high SCOFF scores (OR 2.09, 95% CI 1.40 to 3.10) were associated with irregular menstruation. Overall physical activity levels showed no significant association with menstruation. In subgroup analysis, low body mass index and disordered eating symptoms were associated with irregular menstruation among casual exercisers whereas school burnout was associated with irregular menstruation among competitive athletes.Conclusion School-related stress, eating and exercise habits should be evaluated among high school students presenting with menstrual irregularities, as these factors may be relevant in identifying adolescents at risk of more severe reproductive dysfunctions, including amenorrhoea.
Objectives:To derive sex-specific peak oxygen uptake (VO2peak) reference equations for cycle ergometer cardiopulmonary exercise testing (CPET) that integrate estimations of lean body mass (eLBM) and body fat percentage (eBF) based on sex, age, height and weight. Methods:We pooled data from apparently healthy adults who performed cycle ergometry in Belgium (FLEMENGHO and iCOMPEER cohorts) and the USA (FRIEND registry). Per subgroup of sex, age and body mass index (BMI), 70% of the data was used for training the equations and 30% for testing them. Results:The cohort consisted of 1778 females and 1243 males. For females, the mean age was 49.8±13.3 years, BMI 27.1±4.9 kg·m-2 and VO2peak 1488.4±360.3 mL·min-1. For males, the mean age was 50.2±13.3 years, BMI 27.6±4.0 kg·m-2 and VO2peak 2467.1±595.5 mL·min-1. The reference equation for females was V O 2 p e a k , f e m a l e s [ m L × m i n - 1 ] = 1335.9 + 31.3 × e L B M ( k g ) - 21.8 × e B F ( % ) - 0.119 × a g e 2 .In the test set, the SE of VO2peak estimates (SEE) was 279.9 mL·min-1. For males, the equation was V O 2 p e a k , m a l e s [ m L × m i n - 1 ] = 2264.4 + 42.5 × e L B M ( k g ) - 71.2 × e B F ( % ) - 0.134 × a g e 2 .In the test set, SEE=434.2 mL·min-1. Per cent-predicted VO2peak calculated with the proposed equations presented a good calibration among subgroups. Conclusion:The proposed equations allowed calibrated comparisons of an individual's VO2peak to that of healthy individuals matched by sex, age and estimated body composition.
Background:Preparticipation cardiovascular evaluation (PPE) is widely recommended to reduce the risk of sudden cardiac events in athletes; however, the optimal screening protocol remains debated. Although resting ECG and echocardiography are commonly used, intermittent arrhythmias may remain undetected. Objective:To assess whether the addition of 24-hour ambulatory ECG (Holter) monitoring, including during sleep and training, increases the detection of potentially pathological cardiovascular findings. Design and settings:This observational cross-sectional study included athletes (aged 14-42 years) from a Spanish elite multisport professional club undergoing pre-season PPE during the 2023-2024. All athletes completed a standardised evaluation comprising medical history and physical examination, resting 12-lead ECG, transthoracic echocardiography and 24-hour wireless Holter monitoring performed during daily activities including at least one training session. Detection rates of potentially pathological findings were compared across screening test combinations. Participants:Of 343 athletes recruited, 299 (79.6% male; mean age 22 years) were included in the final analysis. Results:Potentially pathological findings prompting further evaluation were identified in 34 athletes (11.3%). The addition of any single test to medical history and physical examination significantly increased detection rates. Holter monitoring identified more intermittent arrhythmic events, particularly during exercise or sleep, whereas resting ECG more frequently detected repolarisation abnormalities. Echocardiography primarily contributed to the identification of structural abnormalities. Following a comprehensive evaluation, only one athlete was disqualified from competition. Conclusions:In elite athletes, integrating Holter monitoring into PPE improved the detection of intermittent arrhythmias that may be missed by a resting ECG alone, and providing complementary diagnostic information and representing a useful adjunct to echocardiography in comprehensive cardiovascular screening strategies, particularly in selected high-risk athletic populations. Future longitudinal studies are warranted to determine the clinical significance of these findings.
Background Marathon running has numerous cardiovascular effects. Studies report transient physiological changes, while others identify possible harmful cardiovascular changes. This systematic review and meta-analysis aimed to characterise acute cardiac effects of marathon running.Methods A systematic search was conducted in PubMed, Embase, and SPORTDiscus up to 11 April 2025. Studies were included if they reported (i) primary data (ii) in English (iii) healthy adults completing a road marathon, (iv) quantitative pre- and post-marathon cardiac effects. After data extraction (myocardial biomarkers, morphology, and function), random-effect meta-analyses were performed to determine mean differences and relative changes between pre- and post-marathon. Meta-regression analyses were performed in metrics with ≥7 studies.Results Of 9080 articles, 69 were eligible for systematic review (3274 participants: age 30–55 years, >80% men) and 49 for meta-analysis on three biomarkers, 18 echocardiography metrics, and five cardiac MRI metrics. Marathon running-induced increases in circulating troponin T (+42 (32.6, 52.3) ng/L; p<0.001), troponin I (+77 (55.1, 98.3) ng/L; p<0.001) and N-terminal pro B-type natriuretic peptide (NT-proBNP) (+114 (89.0, 138.6) ng/L; p<0.001). On echocardiography, left ventricular (LV) volume and diastolic function, and right ventricular (RV) systolic function decreased post-marathon, while RV end-systolic and diastolic volumes increased. Cardiac MRI revealed an increase in LV ejection fraction. On meta-regression analysis, these responses varied according to age, sex, training status and marathon performance.Conclusion Marathon running induces acute changes in biomarkers of myocardial injury, cardiac structure and function. The clinical significance and potential for harm of these changes are yet to be established.PROSPERO registration number CRD42023399120
Objectives Hamstring strain injuries (HSI) are a leading cause of time loss and reinjury in elite sport, yet return-to-sport (RTS) decisions remain largely based on physical criteria. This scoping review aimed to map the psychological, social and contextual factors associated with RTS after HSI and to examine how psychological readiness has been conceptualised in RTS after HSI.Methods Following Joanna Briggs Institute methodology, seven databases (MEDLINE, Embase, PsycINFO, CINAHL, SPORTDiscus, Scopus and ProQuest) were systematically searched for studies published until September 2025 in five languages. Eligible studies included original research identifying or describing psychological, social or contextual factors influencing RTS after HSI. Methodological quality was assessed using the Mixed Methods Appraisal Tool and the Oxford Centre for Evidence-Based Medicine. Data were synthesised thematically.Results 10 studies (n=663 participants, mostly in elite football) met the inclusion criteria. Three overarching domains were identified. Psychological factors were most frequently reported, including anxiety, fear of reinjury or failure and self-perceived readiness, as well as motivation and self-efficacy. Social factors encompassed therapeutic alliance, communication within the rehabilitation team and hierarchical dynamics within professional environments. Contextual factors referred to situational and organisational influences such as season timing, resource availability and operational practices. Psychological readiness was inconsistently defined and typically assessed informally rather than through validated instruments.Conclusions Psychological, social and contextual factors are under-screened in RTS after HSI. Incorporating structured psychosocial screening and shared decision-making alongside physical criteria may improve RTS safety and sustainability. Athlete-centred research is warranted to refine the assessment of psychological readiness and inform holistic, context-sensitive RTS frameworks.
Objective:To synthesise evidence on exercise for preventing and managing non-communicable diseases (NCDs) among HIV clients, emphasising sub-Saharan Africa. Design:Narrative review. Data sources:Meta-analyses, randomised trials, cohort studies, mechanistic investigations and implementation reports involving adolescents and adults aged 15+ Priority was given to cardiometabolic, musculoskeletal, neurocognitive, immunological, behavioural, safety, feasibility and low- and middle-income country outcomes. Rationale:People living with HIV face elevated risk of cardiovascular disease, heart failure and type 2 diabetes due to persistent immune activation, chronic inflammation and treatment related metabolic effects. Exercise is a scalable, low-cost intervention with broad benefits. Results:Aerobic and combined aerobic plus resistance training performed ≥3 times weekly for ≥5 weeks improves cardiorespiratory fitness and functional capacity with moderate effects, without adverse effects on CD4 or viral load. Resistance and concurrent training increase strength and lean mass and may attenuate bone mineral density loss. Exercise reduces depressive symptoms, improves quality of life and benefits attention and executive function. Mechanistic studies report reduced pro inflammation, improved endothelial function, enhanced mitochondrial capacity and greater antioxidant defence. Feasibility is high with appropriate screening and progression and with adaptations for neuropathy, frailty, pregnancy, low bone density and multimorbidity. Task shifting, digital or community delivery improve uptake despite limited evidence. Conclusions:Exercise should be integrated into HIV and NCD care using frequency, intensity, time and type principles. Programmes require risk stratification, age and sex sensitivity and behaviour change support. Further research should evaluate mechanistic endpoints, high-intensity interval training dosing, pragmatic delivery models and economic outcomes in low- and middle-income countries.
Objective Cardiac troponins (cTns) are frequently measured in patients when suspecting coronary artery disease (CAD). However, recent studies suggest that elevated cTns following exercise may predict CAD and increased mortality. Although the mechanisms underlying postexercise cTn increase remain unclear, the cardiac troponin I (cTnI)/cardiac troponin T (cTnT) ratio shows promise for distinguishing cardiac pathologies. This study assesses the dynamics of cTnI and cTnT concentrations and the cTnI/cTnT ratio in serum samples collected 1–2 days before, within 1 hour after and 11–24 hour after completing Norseman Xtreme Triathlon.Methods Using Abbott’s STAT High Sensitive Troponin-I assay and Roche’s Elecsys Troponin T hs assay, we measured cTnI and cTnT in venous serum of 93 adult triathletes.Results Concentrations of cTnI, cTnT and cTnI/cTnT ratio increased from baseline to immediately after the race (cTnI median (25–75 percentile) from (3 (2–6) ng/L) to 69 (37–156) ng/L, cTnT from (6 (5–8) ng/L) to 40 (24–55) ng/L and cTnI/cTnT from (0.5 (0.3–0.8)) to 2.1 (1.5–2.9), all p<0.001). Serum cTnI and cTnT concentrations remained elevated the day after the race, whereas the cTnI/cTnT ratio declined the day after the race compared with baseline levels. Three participants displayed higher cTnI levels, and 14 participants showed higher cTnI/cTnT ratios the day after the race compared with immediately after.Conclusion Serum concentrations of cTnI, cTnT and the cTnI/cTnT ratio increase immediately after a long-distance triathlon, and concentrations trend towards normalisation the next day. The clinical implications are unknown and warrant further investigation.
Sedentary behaviour is associated with an increased risk of cardiovascular disease and all-cause mortality in people with type 1 diabetes (T1D). Recent research has found that interrupting prolonged sitting with low-intensity activity acutely improves glycaemic management in people with T1D who use multiple daily insulin injections or continuous subcutaneous insulin infusion. However, the acute glycaemic effects of breaking up sitting with low-intensity walking on people with T1D using hybrid closed-loop (HCL) insulin systems are yet to be examined. The primary aim of the present study is to investigate the influence of breaking up 7 hours of sitting with 3 min intervals of low-intensity walking every 30 min on glucose management in individuals with T1D who use HCL systems. Adults with T1D (n=24), who use HCL systems, will complete two experimental conditions in this randomised cross-over trial. One condition will require sitting uninterrupted for 7 hours (Sedentary), while the other will require breaking up 7 hours of sitting with 3 min of low-intensity walking every 30 min (Active Breaks). During both conditions, interstitial glucose concentrations (via CGM) and insulin administration (via HCL) will be recorded throughout. In addition, peripheral vascular function (via flow-mediated dilation) and cerebral vascular function (via CO2 reactivity) will be measured at baseline and post. Data will be analysed using paired t-tests and analyses of variance. The trial has been approved in the UK by the London City and East Research Ethics Committee (25/PR/0098). The findings from the study will be disseminated through peer-reviewed journals and presentations at national and international scientific conferences. Trial registration number: ISRCTN56375691.
Objective To examine gambling behaviours and problem gambling among Swedish male junior elite football players, including differences between players below and above the legal gambling age, and to identify gambling-related risk factors.Methods A cross-sectional survey was conducted among players in the U16, U17 and U19 teams of the 32 clubs in the two highest divisions. In total, 741 players responded (43.3%). Past-year problem gambling was assessed using the Problem Gambling Severity Index and depressive symptoms using the Patient Health Questionnaire-9. Multivariable logistic regression was used to examine correlates of problem gambling.Results Overall, 32% had gambled in the past year, with higher participation among players who had reached the legal gambling age (63.2% vs 22.4%). Problem gambling was nearly two times as common in this group (13.4%) compared with younger players (7.5%). Slots participation showed the strongest association with problem gambling followed by depressive symptoms. Awareness of gambling policies within clubs was low (15%).Conclusions Gambling and problem gambling are more common among junior elite footballers, including underage players, than in the general population. The sharp increase in gambling after reaching the legal age, combined with low policy awareness, highlights the need for preventive interventions, clearer gambling policies and education within football clubs.
Aromatase inhibitors are the standard adjuvant hormone therapy for postmenopausal women with hormone-sensitive breast cancer. However, nearly half of patients experience aromatase inhibitor-associated musculoskeletal syndrome (AIMSS), predominantly pain, which compromises quality of life and treatment adherence. While adapted physical activity offers proven benefits in oncology, its specific role in preventing or managing AIMSS remains unclear. Moreover, the maintenance of physical activity throughout the care pathway in real-world settings is limited, underscoring the need for hybrid approaches that assess both clinical effectiveness and implementation. In response to these challenges, the primary study aim will be to compare the prevalence of musculoskeletal pain at 6 months of aromatase inhibitor therapy between patients who initiate a personalised, adapted physical activity programme at the beginning of the care pathway and those who receive usual care. Secondary aims will be to (1) assess additional effects of the intervention on physical health, psychosocial well-being and treatment adherence, (2) explore contextual factors influencing programme implementation in routine oncology care and (3) identify potential risk factors for the development of AIMSS.The APIS study is a hybrid type I effectiveness-implementation randomised controlled trial including 182 postmenopausal women with non-metastatic hormone-sensitive breast cancer.APIS will generate new evidence on the clinical and implementation effectiveness of early personalised adapted physical activity in preventing AIMSS. The hybrid design will support the development of sustainable, patient-centred interventions potentially improving quality of life, adherence to hormone therapy and long-term outcomes in breast cancer survivorship.Trial registration numberNCT07295457.
Objectives Chondral defects of the knee can impair function, reduce quality of life and accelerate progression to osteoarthritis. Treatment aims to delay further cartilage damage and reduce the risk of early-onset osteoarthritis and knee replacement. This systematic review evaluated the effectiveness and safety of chondral defect repair procedures on the knee.Design Systematic review.Data sources PubMed and Cochrane Library.Eligibility criteria for selecting studies Interventions were matrix-induced autologous chondrocyte implantation (MACI), osteochondral autologous transplantation (OATS) and cell-free implants. Comparators included microfracture (MF). Eligible study designs were randomised controlled trials (RCTs) and comparative non-randomised studies of interventions (NRSIs). Eligible outcomes included patient-reported outcomes (PROs), clinical response, treatment failure, reoperation and harms. Risk-of-bias assessments (RoB) on all included studies were assessed using the Cochrane Risk of Bias (RoB 2) for the RCTs and Risk Of Bias In Nonrandomized Studies of Interventions tool for the NRSIs.Results 13 studies reported effectiveness and 8 studies reported harms. MACI was more effective than MF, measured by PROs and response to treatment (moderate certainty of evidence (COE) from RCTs, very low to low COE from NRSIs). Evidence comparing OATS with MF suggested no difference in effectiveness, as measured by PROs (low COE from RCTs and very low COE from NRSIs). MACI and OATS had similar harms to MF (COE low and very low). Evidence for cell-free implants suggested greater effectiveness (moderate COE) and fewer harms (low COE) compared with MF. No studies compared these procedures to sham surgery or conservative management.Conclusion MACI and OATS showed greater or comparable effectiveness compared with MF. Harms were comparable between procedures, though reporting was sparse. Rigorous study design, standardised effectiveness outcomes and consistent reporting of harms would strengthen the evidence base. These findings can inform clinical decision-making and identify future research needs.
Competitive athletes consistently demonstrate high rates of oral disease. This mixed-methods study investigated and compared the knowledge, beliefs and attitudes of athletes, coaches and dental healthcare professionals (DHPs) regarding oral disease prevention in a cohort of predominantly endurance athletes to inform future targeted health promotion. An online questionnaire was used to collect quantitative and qualitative data from sub-elite competitive endurance athletes, coaches, and DHPs, which were analysed using a mixed-methods approach. Responses from 67 athletes, 33 coaches, and 33 DHPs were analysed. Median knowledge scores were poor for athletes and coaches (36.4%) and DHPs (45.5%), with 0% as the lowest possible score and 100% the highest. Few coaches considered dental disease prevention part of their role, although most acknowledged responsibility for broader athlete health. DHPs applied evidence-based preventive principles to all patients but exhibited limited awareness of sport-specific risk factors and reported barriers in treating athletes, including time constraints and limited knowledge of the competitive sports environment. Overall, knowledge of dental disease prevention in competitive sport was low across all groups. Targeted educational and behavioural interventions could help reduce disease burden and its impact on athlete performance and well-being.
Background/Aim In professional soccer, comprehensive musculoskeletal assessments are performed prior to player transfers to evaluate both the current condition and future risk of injury. MRI plays a crucial role in this process, effectively revealing musculoskeletal findings even in the absence of symptoms. This study presents common musculoskeletal MRI findings in professional soccer players undergoing pre-signing assessments and their associations with age, playing position and footedness.Methods In this retrospective study, musculoskeletal 3 Tesla MRI scans obtained during pre-signing medical assessments of professional soccer players from August 2019 to March 2025 were included. Clinical data were extracted from medical records and supplemented with publicly available player information. Structural abnormalities exceeding expected physiological or age-related adaptations were systematically recorded and categorised according to institutional reporting practice.Results A total of 50 professional soccer players (mean age 25.4±4.7 years) were included. The most frequent MRI findings were secondary cleft signs and lumbar degenerative disc changes (in 21/50 and 20/50 players), followed by chondropathy of the knee (34%), labral degeneration (26%), femoroacetabular impingement (22%) and other soft tissue or bone-related changes. The prevalence of secondary clefts differed significantly across playing positions (χ²=8.07, p=0.045) with strikers showing the highest proportion (68.75%) compared with other groups.Conclusions Routine MRI screening in professional soccer players revealed typical frequent structural changes, even in the absence of symptoms. While most findings were consistently distributed across positions, some showed variation depending on playing position. These results highlight the value of early imaging in guiding individualised monitoring and injury prevention strategies.
