Acute musculoskeletal injuries are common among sports participants and are frequently treated with topical analgesics; however, the comparative efficacy and safety of topical formulations remain under investigation. The objective of this study was to evaluate the efficacy and safety of topical nonsteroidal anti-inflammatory drugs (NSAIDs) and alternative topical therapies in the management of acute sports-associated soft tissue injuries, including sprains, strains, contusions, and soreness. A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, including randomized controlled trials that evaluated topical NSAIDs or other topical analgesics in patients with acute sports-related musculoskeletal injuries. Bias was assessed with the RoB-2 tool. The primary efficacy outcome was reduction in pain, measured by the visual analog scale (VAS) or similar validated tools, while the primary safety outcome was the incidence of treatment-emergent adverse effects. Eight randomized controlled trials comprising 1027 patient encounters met inclusion criteria. Across studies, topical diclofenac, ibuprofen, ketoprofen, and etofenamate demonstrated statistically significant reductions in VAS pain scores compared with placebo. Meta-analysis of all included trials revealed no significant reduction in pain intensity in active topical interventions versus placebo (95% CI -0.3768-5.2806; p = 0.09). A direct comparative analysis of diclofenac versus other NSAIDs did not demonstrate a statistically significant difference (effect size -2.07; 95% CI -5.60-1.46; p = 0.25), though heterogeneity of studies may limit these findings. Adverse effects were primarily mild and localized and were no different between groups (RR = 0.79; 95% CI 0.45-1.39; p = 0.41). Topical NSAIDs and alternative topical formulations may provide improved pain outcomes but did not show superiority between NSAID agents.
Background:Individuals with chronic ankle instability (CAI) often exhibit decreased physical activity (PA) which may increase sedentary behavior and chronic disease risk. However, factors contributing to decreased PA in individuals with CAI remain unclear. This study aimed to explore associations between physical function and PA in individuals with CAI. Methods:Thirty individuals with CAI participated and completed clinical assessments of range of motion (ROM), strength, balance, and functional performance. PA was monitored for 4 weeks using a tracker. Pearson correlations were used to examine associations between physical function and PA, followed by backward selection linear regression to identify the best multifactorial model predicting PA. Results:Distance walked and floors climbed were associated with eversion ROM (β = -0.42, p = 0.02; β = -0.40, p = 0.03, respectively). Sedentary minutes were associated with WBLT (β = -0.58, p < 0.001). Light activity minutes were associated with dorsiflexion strength (β = 0.39, p = 0.04). Very active minutes were associated with balance (β = -0.50, p < 0.01) and eversion ROM (β = -0.35, p = 0.04). Number of calories burned was associated with inversion ROM (β = -0.38, p = 0.03). Conclusion:This study suggests that eversion ROM, inversion ROM, WBLT, balance, and dorsiflexion strength may be associated with aspects of PA in individuals with CAI. Rehabilitation programs may consider these factors to support PA.
Previous studies demonstrated that measures of muscle thickness (MT) and echo intensity (EI) show an association with functional tests, but results have been inconsistent. The aim of the current cross-sectional study was to determine which muscle from the quadriceps (QUAD) (i.e., vastus lateralis [VL], rectus femoris [RF], or vastus intermedius [VI]) and ultrasound measurements (i.e., MT and EI) better explain three different physical assessments: maximal isometric knee extension torque (MIVT), vertical jump peak power (VJPP), and lower limb muscle power (LLMP). Forty-three adults (23 women) participated in this cross-sectional study. Participants' body composition, ultrasound measurements from the dominant leg, and functional outcomes were evaluated on the same visit. Bivariate analyses indicated moderate to strong positive associations between all physical assessments and muscle morphology variables, supporting the use of multiple regression analyses. Also, given the multicollinearity among EI measures, a global EI index was generated and used in the multiple regression analyses. The multiple regression analysis showed that MIVT was independently associated with RF MT (p = 0.009) and global EI (p = 0.004), with the model explaining 63.5% of the variance. For VJPP, RF MT was the only variable that significantly contributed to the model (p = 0.041), explaining 61.9% of the variance. Lastly, LLMP was independently associated with RF MT (p = 0.003) and VI MT (p = 0.010), and the model explained 63.0% of the variance. Overall, these findings suggest that RF MT may be the most informative QUAD ultrasound measure for explaining performance in our data set. This is particularly important in clinical and research settings in which reducing testing time, participant burden, and analytic complexity can improve feasibility without substantially compromising the relevance of the evaluation.
Background:Dual-task paradigms are increasingly used to investigate cognitive-motor interactions after anterior cruciate ligament reconstruction (ACLR), yet their effects on hop performance, movement quality and limb symmetry remain insufficiently quantified. The objective of this study was to compare these outcomes under single- and dual-task conditions between individuals after ACLR and healthy controls. Methods:Thirty-one participants (15 ACLR and 16 healthy controls) were included in this multicentre randomised repeated-measures experimental study. Participants performed the single-leg hop for distance (SLHD) under single-task and dual-task conditions using counterbalanced sequences. Movement quality was assessed using the Qualitative Assessment of Single-Leg Landing Scale (QASLS). In the dual-task condition, participants performed the hop while simultaneously completing a standardised visuo-attentional working-memory task. Dual-task cost (DTC) was calculated for SLHD, QASLS and limb symmetry index (LSI). The primary outcome was SLHD DTC. Analyses were based on linear mixed-effect models, with sequence-specific findings reported descriptively to support transparency regarding the counterbalanced design. Results:Under dual-task conditions, SLHD DTC was numerically higher in the ACLR group than in controls in sequences A1 (6.5 ± 6.5% vs 2.7 ± 6.9%; p = 0.227) and A2 (1.1 ± 1.1% vs -0.7 ± 6.8%; p = 0.316), although these between-group differences were not statistically significant. QASLS DTC was not significantly greater in the ACLR group in sequence A1 (0.19 ± 0.23 vs 0.12 ± 0.36 points; p = 0.385) or A2 (0.43 ± 0.28 vs 0.56 ± 0.87 points; p = 0.613). The largest between-group differences were observed for LSI DTC, which was significantly higher in the ACLR group in sequences A1 (3.8 ± 1.9% vs 0.7 ± 1.3%; p < 0.001) and A2 (6.5 ± 2.4% vs 0.6 ± 1.2%; p < 0.001). Repeated-condition sequences B1 and B2 were retained to explore potential order, learning and fatigue effects and were not interpreted as DTC sequences. Sequence-specific descriptive findings in the ACLR group showed dual-task-related effects for limb symmetry in A1 and A2, whereas controls showed minimal changes. Conclusion:Dual-task conditions were associated with measurable changes in SLHD performance, movement quality and limb symmetry after ACLR. Trail Registration: Clinical trial.gov.identifier: NCT06768957.
Insulin resistance (IR) may jeopardise cerebral oxygenation and increase perceived exertion during exercise. We investigated whether IR is independently associated with perceived exertion or cerebral oxygenation during exercise and whether perceived exertion is associated with cerebral oxygenation during exercise. 48 premenopausal apparently healthy women underwent a cardiopulmonary exercise test (CPET) in this retrospective cross-sectional study. We assessed IR with the homeostasis model assessment (HOMA-IR). In addition to basic CPET data, we quantified cardiac function (impedance cardiography) and prefrontal cerebral oxygenation (near-infrared spectroscopy [NIRS]) during CPET. We divided the subjects into women with HOMA-IR< 3.0 (HOMALOW) vs. women with HOMA-IR≥ 3.0 (HOMAHIGH), and into women with lower RPE/MET (rating of perceived exertion/metabolic equivalent) slope (RPE/METLOW) vs. women with higher RPE/MET slope (RPE/METHIGH). RPE or NIRS responses to exercise did not differ between HOMA-IR groups. NIRS responses to exercise did not differ between RPE/MET groups. NIRS responses did not correlate with HOMA-IR or RPE/MET slope in all subjects. In multivariate regression analyses, a higher RPE/MET slope was predicted only by higher body mass index and weaker lung function. In conclusion, we found no associations between IR, cerebral oxygenation, and perceived exertion, whereas body mass index and lung function were independently associated with exercise-related perceived exertion.
Objectives:To investigate the effects of a prenatal exercise intervention on offspring body weight, body mass index (BMI), and lifestyle variables at 7 years of age. Methods:Out of 105 physically inactive participants initially randomized to either a physical activity intervention or control group, 80 women and their children (76.2%) participated in this follow-up study. The intervention consisted of intensive physical activity counseling and supervised, group-based moderate-intensity exercise sessions during the second and third trimesters of pregnancy, while the control group received standard prenatal care only. Data were collected via a standardized telephone interview with the mother and included the offspring's body weight and height, physical activity level, sports participation, and adherence to general health recommendations regarding screen time and diet. Differences between groups were examined using two-sided independent sample t-tests or chi-squared tests as appropriate. Results:Mean BMI was similar in both groups (intervention group: n = 40; control group: n = 40), but the intervention group had fewer children with overweight/obesity (1 vs. 4) and underweight (3 vs. 6) than the control group. There was a nonsignificant trend toward increased physical activity among the offspring of the intervention group compared with the control group. This was reflected in a higher number following guidelines (≥ 60 min of daily moderate-to-vigorous physical activity [MVPA] according to WHO recommendations) (97.5% vs. 87.5%), number of bouts of MVPA per week (6.4 ± 3.8 vs. 5.8 ± 2.3), and daily hours of MVPA in both summer and winter seasons (2.4 ± 1.3 vs. 2.2 ± 1.3 and 1.6 ± 1.0 vs. 1.4 ± 1.0). The intervention group also reported higher rates of active school transportation than the control group (72.5% vs. 57.5%). No differences were observed in sedentary screen time and diet between the groups. Conclusions:Our results suggest that the intervention may have positively influenced the BMI status and physical activity levels of the offspring.
Physical exercise is an important component in obesity and cardiometabolic risk management in adolescents, but improving its effectiveness remains challenging. This study aimed to compare the effectiveness of high-intensity small-sided soccer games (SSSGs) with traditional soccer group (TSG) on physical fitness, body composition, blood pressure, and metabolic risk biomarkers in adolescent boys with increased metabolic risk. Fifty-one boys (11-15 years) with abdominal obesity were recruited and randomly assigned into one of three groups: i) control group (CG; no exercise, n = 17), ii) SSSG (n = 17), and iii) TSG (n = 17). Over 16 weeks, the SSSG and TSG groups engaged in 3 d/week, 60-min exercise sessions, while the CG continued their usual activities without a structured exercise intervention. SSSG consisted of high-intensity soccer games, while the TSG mimicked the usual soccer practices. Assessments for body composition, blood pressure, physical fitness, and metabolic risk biomarkers were conducted at baseline and immediately after the intervention. The results showed that compared to the CG, SSSG significantly decreased fat mass (p = 0.03) and increased fat-free mass (p = 0.05), while TSG led to significant increases in fat-free mass (p < 0.001) and HbA1c (p < 0.01). When comparing both exercise groups, SSSG was shown to be superior in improving fasting insulin (p = 0.03), HOMA-IR (p = 0.03), total cholesterol (p = 0.04), VLDL cholesterol (p = 0.02), triglycerides (p = 0.03), and the cardiometabolic risk index SPISE (p = 0.02). In conclusion, following a 16-week intervention, SSSG was shown to be superior to TSG in improving cardiometabolic health compared to TSG in adolescents with increased metabolic risk. Trial Registration: Clinical trial.gov.identifier: NCT06377137.
Purpose:This study determines the prevalence of ACL injury history among currently active female football players across age groups and playing levels and examines the association between ACL injury history and activity-related knee pain. Methods:A total of 1026 active Danish female youth- and senior-league football players were invited to an online questionnaire (response rate: 751 [73%]) on (1) ACL injury history and (2) present knee pain during physical activity. Prevalence was calculated separately according to age (youth vs senior) and playing level (non-elite vs elite). Logistic regression analyses investigated factors associated with the prevalence of ACL injury history and activity-related knee pain, respectively. Results:The prevalence of ACL injury history was 5.0% (95% confidence interval [CI] 3.3%-7.4%) in youth football and 14.8% (95% CI 10.6%-19.8%) in senior football. The prevalence of activity-related knee pain was comparable between youth (24.6%, 95% CI 20.8%-28.7%) and senior football players (26.0%, 95% CI 20.7%-31.9%). Comparable prevalence of ACL injury history and knee pain was reported at elite and non-elite level. ACL injury history was strongly associated with activity-related knee pain (OR = 5.4-8.7, p < 0.0001). Conclusion:Playing with a previous ACL injury is common in active female football players, particularly at senior levels (nearly 1 in 6 elite players). The strong association between ACL injury history and activity-related knee pain underscores the long-term negative consequences. This study highlights the need for secondary and tertiary prevention strategies in female football.
Hamstring strain injuries frequently occur during high-speed running, when muscle tension is markedly increased. Given the viscoelastic properties of muscle, stress during elongation is expected to be velocity-dependent. Therefore, this study investigated the effect of elongation velocity on the stress in individual hamstring muscles. Seven Thiel-embalmed cadaveric lower limbs were used to isolate the biceps femoris long head, semimembranosus, and semitendinosus muscles. Specimens were fixed to a testing apparatus and passively elongated to 10% strain at five elongation velocities (20-300 mm/min), while tensile load and displacement were recorded. Muscle cross-sectional area was measured using ultrasound to calculate stress. A two-way repeated-measures analysis of variance examined the effects of muscle and velocity on stress at 10% strain. The results revealed no significant interaction between muscle and velocity (p > 0.05); however, both velocity and muscle had significant main effects on stress (p < 0.001). Post hoc analysis indicated that stress increased significantly with velocity (20 mm/min: 44.6 kPa, 50 mm/min: 47.4 kPa, 100 mm/min: 50.8 kPa, 200 mm/min: 56.4 kPa, 300 mm/min: 61.1 kPa). These findings suggest that stress in the hamstring muscles increases with elongation velocity, which may contribute to the risk of strain injuries during high-speed running. However, the results should be interpreted in the context of cadaveric testing and elongation velocities that are substantially lower than those observed in vivo.
Objectives:To compare the acute effect on exercise-induced hypoalgesia (EIH) between isometric exercise with blood flow restriction (BFR) and isometric exercise alone in adults undergoing arthroscopic RC repair and to determine the level of correlation between EIH and kinesiophobia, disability and quality of life. Design:Blinded randomized crossover clinical trial. Patients:Twenty-three adults with degenerative rotator cuff (RC) repair. Intervention:Patients completed three shoulder isometric exercises. They were randomized to receive isometric exercises alone (control intervention) or isometric exercises with BFR (experimental intervention) in the first session and the alternate condition in the next session. Outcomes:Primary outcomes included pressure pain threshold (PPT) and conditioned pain modulation (CPM), assessed before, immediately after, and 10 min after isometric exercises with BFR and isometric exercises alone. Results:In the affected limb, BFR isometric exercises increased PPT immediately after exercise in upper trapezius (MD: 0.4 kg/cm2 [CI95% 0.1 to 0.9]), and in the unaffected limb, BFR isometric exercises increased deltoid PPT immediately after exercise (MD: 0.4 kg/cm2 [CI95% 0.1 to 0.7]). However, post hoc between-group comparisons showed that no significant differences existed between BFR and control at any time point, as all CI95% crossed zero and these changes did not exceed the minimum detectable change (≈1.1 kg/cm2). Besides, isometric exercise alone increased deltoid CPM immediately after in affected limb (MD: 30.1% [CI95% 10.8 to 49.4]) and 10 min after exercise in unaffected limb (MD: 12.0% [CI95% -0.4 to 24.4]). No significant changes were found in clinical pain intensity measured by the visual analog scale (VAS) at any time point. Statistically significant weak correlations were found between PPT with Western Ontario Rotator Cuff (WORC) index (r = -0.322 for sport, r = -0.331 for work, r = -0.302 for lifestyle; p < 0.05) and Shoulder Pain Disability Index (SPADI) (r = -0.309; p < 0.05), respectively. Conclusion:A single session of low-intensity isometric exercises with BFR did not produce a clinically meaningful EIH response nor was it superior to isometric exercise alone in patients after RC repair. The observed statistical signals did not reach the minimum detectable change, and the inconsistent CPM shifts suggest that BFR does not provide an additional acute advantage for endogenous pain modulation in this early postoperative stage. Trial Registration: ClinicalTrials.gov identifier: NCT06924112.
Background:Football requires high levels of neuromuscular conditioning to meet the demands of explosive actions such as sprinting, cutting, and kicking, while minimizing the risk of lower limb injuries-especially hamstring strains linked to muscle imbalances. Single-leg cycling (SLC), a form of unilateral training, may offer superior neuromuscular adaptations compared to traditional double-leg cycling (DLC). This study aimed to compare the effects of SLC and DLC on lower limb strength, anaerobic power, fatigue resistance, agility, and sprint performance in competitive football players. Methods:A four-week, assessor-blinded randomized controlled trial was conducted on 42 male football players (aged 18-26), allocated equally to SLC (n = 21) and DLC (n = 21) groups. Both groups underwent biweekly cycling sessions. Pre- and postintervention assessments included isokinetic peak torque of knee flexors and extensors, hamstring-to-quadriceps (H/Q) ratio, peak and minimum power, fatigue index (RAST), 20-m zig-zag agility test, and 30-m Sprint Test. Results:Both groups showed significant improvements in anaerobic performance metrics (peak and minimum power, p < 0.001). However, SLC yielded significantly higher gains in knee flexor peak torque (Δ + 46.7%, p < 0.001) and H/Q ratio (Δ + 30.2%, p = 0.02), indicating superior hamstring activation and improved muscle balance. Fatigue index significantly decreased only in the SLC group (Δ - 7.3%, p = 0.04), reflecting enhanced anaerobic endurance. SLC also resulted in greater improvements in agility (Δ - 5.9%) and sprint performance (Δ - 8.1%) compared to DLC (p < 0.001), suggesting improved neuromuscular coordination and explosive capability. Knee extensor torque increased modestly in both groups, with no significant between-group difference (p = 0.46). Conclusion:SLC training offers superior benefits over DLC in improving lower limb strength balance, fatigue resistance, agility, and sprinting in football players. It may serve as a targeted conditioning strategy to enhance performance and reduce injury risk in sport-specific contexts. Trial Registration: Clinical Trials Registry-India (CTRI): CTRI/2023/06/053941.
Accurate identification of anxiety and depression in collegiate athletes is critical to timely intervention. Baseline concussion testing, such as the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), may provide a unique, practical avenue for screening mental health concerns. The objective of this study was to determine whether the symptom cluster scores from ImPACT can predict anxiety and depression in collegiate athletes. 560 athletes (43.7% female; 16% ADHD) completed baseline assessments preseason. Symptom clusters (e.g., affective) were derived from ImPACT and compared with scores on the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). Hierarchical regression analyses examined whether ImPACT clusters and demographic factors could predict anxiety and depression. Gender and ADHD explained a small but significant portion of the variance in depression (R 2 change = 0.040, p < 0.001), cognitive clusters (R 2 change = 0.018, p < 0.001), and affective clusters (R 2 change = 0.259, p < 0.001). In the prediction of anxiety, the affective cluster was again the strongest predictor, contributing to a substantial increase in explained variance (R 2 change = 0.257, p < 0.001), followed by demographic factors, sex, and ADHD, which explained a smaller portion of the variance (R 2 change = 0.035, p < 0.001). ImPACT concussion symptom clusters appear to be a useful tool for preemptive screening of anxiety and depression in collegiate athletes. Including this utility in existing concussion protocols, which ubiquitously use ImPACT, may facilitate earlier identification of at-risk individuals for a more targeted intervention to support student-athletes' psychological well-being.
The increase in combat sports practice and the creation of weight divisions for fairer competitions led to dehydration practice as a strategy of inclusion in inferior divisions. However, this technique can damage kidney and heart functions due to alterations in blood volume. This study evaluated the acute effects of weight loss through dehydration on the kidney function of Mixed Martial Arts and Muay Thai fighters. The sample was composed of 30 athletes of both Mixed Martial Arts (n = 15) and Muay Thai (n = 15) fighters. Both groups went through two protocols for collecting data about the athlete's profile, vital signs, and urinary and blood samples in three different moments: before weigh-in, official weigh-in day, and fight day. The athletes' profiles and the dehydration methods employed were found to be consistent with those reported in the literature. The participants lost weight 1 month before the fight and had alterations that developed into glycosuria, leukocyturia, and proteinuria noted on both official weigh-in and combat days. Proteinuria and high creatinine depuration suggest acute kidney damage with an increase in filtration rate due to dehydration. As shown, there is a necessity for proper athlete orientation regarding dehydration and possible damage to the body's physiological integrity and sport performance, and developing a guide on more appropriate weight control protocols that do not put athletes' health at risk should be established and publicized.
Background:Various protein-based dietary supplements are widely used by individuals engaged in strength training to optimize gains in muscle strength and fat-free mass. However, gaps remain in the scientific literature regarding a comprehensive comparison-particularly the effectiveness of different types of supplemented proteins in healthy adults. This systematic review and network meta-analysis aimed to compare the effectiveness of protein-based dietary supplements, combined with strength training, on increasing muscle strength and fat-free mass in healthy adults. Methods:A network meta-analysis was conducted using randomized controlled trials evaluating different protein supplements combined with strength training. The outcomes assessed were muscle strength (primary) and fat-free mass (secondary). The search was performed in PubMed, Scopus, and Embase up to May 2024, with no restrictions on language or publication date. Results:A total of 78 studies were included, comprising 4755 participants across two outcomes and involving 13 types of protein supplements, plus placebo and control groups. Compared to placebo, for strength, collagen was the most effective supplement (SMD = 0.41; 95% CI: 0.09 to 0.73; p = 0.0125; SUCRA 88.05%), followed by whey protein (SMD = 0.15; 95% CI: 0.03 to 0.27; p = 0.0145; SUCRA 64.34%). The other supplements showed no statistically significant differences compared to placebo (p > 0.05). For fat-free mass, results were similar. Collagen showed a statistically superior effect (SMD = 0.94; 95% CI: 0.48 to 1.40; p < 0.0001; SUCRA 98.92%), followed by whey protein (SMD = 0.16; 95% CI: 0.05 to 0.28; p = 0.0051; SUCRA 60.23%). Other supplements showed no statistically significant differences (p > 0.05). Conclusion:Collagen and whey protein are the only protein supplements effective in enhancing strength training effects. Moreover, collagen shows a superior effect compared to whey protein for both outcomes.
Adolescent female handball players are at elevated risk of anterior cruciate ligament (ACL) injury. Early interventions during preadolescence seem crucial for improving motor strategies and potentially preventing injuries. This randomised controlled trial on preadolescent female handball players investigated the effects of an 8-week ACL injury prevention program (ACL-IPP) targeting modifiable neuromuscular and biomechanical risk factors and assessed retention effects 8 weeks post-intervention. Thirty-five elite preadolescent female handball players (11-13 years old) were randomised to the ACL-IPP group (n = 18) or a control group that performed shoulder injury prevention exercises (n = 17), with supervised training conducted for 15 min twice weekly. Biomechanical and neuromuscular assessments of participants' side-cutting manoeuvres were performed at baseline, immediately after the 8-week intervention (post-intervention) and at an 8-week follow-up (16 weeks from baseline). The primary outcome was the between-group change in m. semitendinosus EMG preactivity, measured during the 50 ms preceding initial contact of the side-cutting manoeuvre at 8 weeks. There were no significant between-group differences in changes in semitendinosus preactivity (p = 0.950), isometric hip external rotation strength, hip flexion, knee internal rotation at initial contact or peak knee abduction moments of the handball-specific side-cut manoeuvre. Similarly, no retention effects were observed after 16 weeks. These findings suggest that the implemented 8-week ACL-IPP was insufficient to elicit meaningful improvements in ACL injury risk factors in this population. Greater training volume, different exercise selection and/or extended intervention duration may be required to induce neuromuscular and biomechanical adaptations in preadolescent female handball players. Trial Registration: ClinicalTrials.gov identifier: NCT05955599.
The Lisfranc ligamentous complex is the principal stabilizer of the tarsometatarsal joint and functions as the midfoot keystone. Injuries often follow an axial or rotational load applied to a plantarflexed foot, producing ligamentous disruption or, in severe cases, fracture-dislocation of the tarsometatarsal complex. Up to one-third of Lisfranc injuries are initially missed, particularly in low-energy mechanisms or polytrauma settings. Weight-bearing radiographs are essential for detecting subtle injuries and uncovering diastasis between the medial cuneiform and the second metatarsal. The Myerson classification categorizes injuries based on joint congruity, the direction of displacement, and extent of involvement. The decision to pursue conservative or surgical treatment depends on the Lisfranc ligament stability and displacement. Nonoperative management is appropriate only in nondisplaced injuries; delayed treatment can result in persistent midfoot pain, arch collapse, post-traumatic arthritis, and diminished function. Surgical techniques include open reduction and internal fixation, primary arthrodesis, bridge plating, suture button fixation, and percutaneous approaches. Lateral column injuries involving the fourth and fifth tarsometatarsal joints are advised to be treated with K-wire fixation. Anatomic alignment is the strongest predictor of successful recovery and return to activity. Residual displacement > 2 mm is associated with inferior outcomes and significantly reduced return-to-play rates, particularly in athletes who can have lasting effects even with successful fixation and may not reach preinjury performance levels. Optimal management is yet to be determined, and inadequate fixation increases poor outcomes, underscoring the importance of early recognition, precise reduction, and appropriate fixation strategy. This study is novel and integrates recent evidence including diagnostic and prognostic utility of weight-bearing, the clinical outcomes and biomechanics of treatment approaches including flexible fixation constructs such as suture button systems, and postoperative outcomes including gait analysis, return-to-play, and athletic performance outcomes.
Background:Research on the association between changes in handgrip strength (HGS) and risk factors for lifestyle-related diseases in children and adolescents may help clarify the inverse association between HGS and morbidity/mortality. Objective:This systematic review with meta-analysis aimed to investigate the cross-sectional and longitudinal associations between HGS and markers of insulin resistance and inflammation in children and adolescents. Methods:Observational studies that investigated the cross-sectional and/or longitudinal associations between HGS and markers of insulin resistance and inflammation in children and adolescents were searched. Summary effect size measures were calculated using a random-effects model estimation and reported as Fisher's r-to-z transformed correlation coefficients and 95% confidence intervals. Results:Fifteen studies (12 cross-sectional, two cross-sectional and longitudinal, and one longitudinal) were included in the systematic review, of which 11 studies were also included in the meta-analyses for cross-sectional correlation. Relative (per body mass) but not absolute HGS was significantly associated (very low evidence) with markers of insulin resistance. Relative HGS was also significantly associated (very low evidence) with most of the inflammatory markers investigated. The three longitudinal studies included had insufficient information to perform a meta-analysis. Conclusions:The results from cross-sectional studies indicated the association (very low evidence) between HGS and several markers of insulin resistance and inflammation existed when studies utilized the relative HGS per body mass. However, no significant relationship was found when studies used absolute HGS. Furthermore, as longitudinal studies were limited, future longitudinal follow-up studies are an important means of resolving these issues.
Background:Current return-to-sport screening paradigms after anterior cruciate ligament (ACL) injury are inadequate as they fail to reflect cognitive-motor sports demands. This pilot study aimed to evaluate dual-task ability in individuals with ACL reconstruction (ACLR) using a novel dual-task test paradigm. Specifically, we compared (1) cognitive and motor performance between individuals with ACLR and controls, (2) hop test performance between the injured and non-injured legs within the ACLR group, and (3) performance across test-retest sessions. Materials and Methods:Twenty sports active individuals (10 ACLR, 10 controls) performed the dual-task paradigm twice within a week, comprising a cognitive test, a dual-task drop-vertical hop test, and an upper-body hand-tapping test. All tests incorporated a visuospatial working-memory task (cognitive performance), with the latter two additionally engaging attention, decision-making, and inhibitory control (motor performance). Between-group, between-leg, and test-retest differences were analyzed using independent and paired t-tests with Cohen's d effect sizes (ESs). Test-retest reliability was examined using intraclass correlation coefficient (ICC), along with the within-person standard deviation and minimal detectable change. Results:No significant differences were observed between ACLR and controls at the first test session (p = 0.09 - 0.34; ESs = 0.19-0.62 [very small-medium]), although ACLR mean performances were 3.8%-14.1% lower. At retest, ACLR performed significantly worse than CTRL for most outcomes (p = 0.01 - 0.03; ESs = 0.91-1.17 [large]) and showed smaller improvements for a hop test outcome (p = 0.04; ES = 0.97 [large]). No differences were found between ACLR legs, both groups improved across test sessions, and test-retest reliability was excellent for ACLR (ICCs = 0.74-0.97) and ranged from poor to excellent in CTRL (ICCs = 0.19-0.86). Conclusions:This pilot study demonstrates the feasibility and preliminary reliability of the dual-task paradigm, particularly within the ACLR group. Poorer cognitive, hop, and upper-body test performances and smaller test-retest improvements for the ACLR group suggest persistent dual-task deficits following injury, supporting the paradigm's utility for ecologically valid ACL rehabilitation and return-to-sport assessment.
Introduction:This study aimed to compare the influence of the knee and hip joint angles on the quadriceps muscles and tendon shear wave velocity (SWV) between men and prepubertal boys. Methods:Ten prepubertal boys and ten men participated in one experimental session, which included SWV measurements at rest for the vastus lateralis (VL), the rectus femoris (RF), and the patellar tendon (PT). Each volunteer was tested in ten randomized positions, including five knee joint angles (30, 50, 70, 90, and 110°, 0° = full extension) and two hip joint angles (0° and 80°, 0° = full extension). The SWV values were analyzed independently with a three-way ANOVA, while considering the knee angle, hip angle, and the age group. Results:Significant knee angle × age interactions were observed for VL (p = 0.008), RF (p = 0.008), and PT (p < 0.001). Boys and men did not present a difference in VL and RF SWV. However, boys exhibited significantly lower PT SWV values than men from a 30° to 90° knee flexion angle (p < 0.001). Additionally, a hip angle × knee angle interaction (p < 0.001) has been observed for RF SWV and highlighted greater values with a 0° hip joint angle, whatever the knee joint angles. Conclusion:These results suggested that boys and men present similar muscle elastic properties in VL and RF. However, lower SWV was observed for PT in boys up to 90° knee joint flexion.
Introduction: Limited knowledge exists regarding how retirement from a professional soccer career may influence players' future quality of life and overall health status. This study aimed to explore the reasons for ending professional soccer careers and to examine the postretirement health and quality of life among former soccer players in Kosovo. Materials and Methods: Seventy-three retired male professional soccer players from Kosovo participated in this cross-sectional study with a retrospective design. The participants completed a questionnaire covering demographics, career details, reasons for retiring, history of soccer-related injuries, current health and activity status, and psychological aspects associated with their professional careers and retirement. Players were divided into two groups: medical retirees (MRs) and nonmedical retirees (NMRs). The Mann-Whitney U test was used to compare continuous data between the two groups, and cross-tabulation methods were employed for categorical data. Results: Nonmedical reasons were the main cause of retirement among Kosovar soccer players (p < 0.001), with job-related issues (58.8%) as the main retirement reason. The NMR group retired later and had longer careers than the MR group, though this was not statistically significant. Lower extremity injuries, particularly ankle and knee injuries, were the most prevalent among all players. After retirement, the NMR group engaged more in physical activity and continued playing soccer significantly more than the MR group (p < 0.001 and p = 0.021). The MR group reported significantly more pain (p < 0.001), analgesic use (p = 0.001), fear of career-ending injuries (p < 0.001), and depression symptoms during their careers (p < 0.001). Overall, NMR had significantly better quality of life and health status than MR (p < 0.001 and p < 0.001, respectively). Conclusions: This study highlights the impact of retirement reasons on the long-term health and quality of life of soccer players in Kosovo. It calls for enhanced support systems to prepare athletes for life after soccer, mitigating negative health outcomes associated with forced retirement due to injuries.
