It is firmly established that balance training leads to significant improvements in postural control in youth. However, little is known about how differences in balance training distribution (i.e., how total training volume is scheduled: duration×frequency), despite the equal total training volume, affect training-induced adaptations. This study was aimed at determining the effect of balance training distribution on balance performance. Twenty-five adolescents (15.8±0.6 y) were randomly assigned to either a 4-week balance training-3×/wk group (massed practice: 4 weeks of balance training for three sessions/wk) or a 6-week balance training-2×/wk group (distributed practice: 6 weeks of BT for two sessions/wk) group. Balance assessments included the timed One-Legged Stance test and the Y Balance Test Lower-Quarter. Significant pretest to post-test improvements were detected for all parameters of the One-Legged Stance test and Y Balance Test Lower-Quarter, irrespective of balance training distribution. Additionally, a group×test interaction ( p =0.041 and η p 2 =0.17) was detected for the posterolateral reach distance in favor of the massed practice group. These findings highlight that most outcomes improved regardless of balance training distribution, and only one outcome showed a benefit for the combination of shorter balance training duration with higher balance training frequency (i.e., massed practice) than vice versa (i.e., distributed practice).
Statistical inference underpins the credibility of sports science research, yet concerns remain regarding the rigor of statistical reporting and analysis. This study assessed the adequacy of statistical practices in sports science research according to established methodological guidelines. A total of 167 original studies published in 2020 across 15 sports science journals indexed in the Journal Citation Reports (Q1-Q3) were systematically reviewed. Up to 50 studies per journal were randomly selected, and data regarding study characteristics and statistical methods were extracted. Statistical adequacy was classified according to predefined criteria involving reporting omissions and/or statistical misapplications. Overall, 87.4% of studies presented at least one inadequacy. The most frequent reporting omissions involved failure to report assumptions such as normality, homogeneity of variances, and sphericity when required. Common statistical misapplications included the use of inappropriate dependent variables and incorrect treatment of independent observations as dependent measures. Deficiencies were identified across all journal quartiles, with no association between adequacy and journal ranking ( p =0.586). These findings raise concerns regarding validity, reproducibility, and practical interpretation in sports science research, reinforcing the need for greater statistical literacy, stricter reporting standards, and improved peer review practices.
Patellofemoral (PF) chondral lesions are a common source of knee pain and disability, typically arising from traumatic (instability/fracture) or degenerative (overload) etiologies. This review synthesizes contemporary evidence on PF joint preservation with an emphasis on avoiding complications. We highlight the importance of defining lesion characteristics and identifying the primary mechanical driver(s) of chondral injury. We then summarize current and emerging cartilage restoration options. Finally, we emphasize that durable outcomes often require concomitant biomechanical optimization through mechanical unloading and soft tissue balancing. Collectively, this review aims to support informed surgical decision-making and maximize long-term survival of the PF joint.
Recurrent patellofemoral instability (PFJI) can result in significant pain, functional limitations, and surgical failure. A thorough understanding of the reasons for such failures is crucial for developing effective revision strategies. This article offers a comprehensive guide to diagnosing and managing failed patellofemoral stabilization surgery, highlighting the multifactorial nature of PFJI and the importance of avoiding a "one-size-fits-all" approach. It explores common pitfalls, including over-reliance on unreliable metrics and technical errors during ligament reconstruction. The paper details practical surgical techniques, such as medial patellofemoral ligament (MPFL), medial patellotibial ligament (MPTL), and medial quadriceps tendon-femoral ligament (MQTFL) reconstruction, and outlines key considerations for tibial tubercle osteotomy and trochleoplasty. A structured diagnostic pathway is proposed to help identify the root cause of surgical failure and ensure a tailored approach to revision.
Recurrent lateral patella instability is primarily a result of lateral patella entry to the femoral trochlea. Using 3-D imaging, one can accurately assess this lateral entry more accurately than with plain radiographs, making 3-D imaging important for optimal surgical planning, particularly when deciding whether to do an anteromedial tibial tubercle transfer osteotomy (AMTTO). To understand the laterality of patella entry to the femoral trochlea of a patient, one must understand the patella entry zone and its midpoint, defined as the entry point (EP) to the trochlea, and then measure its coronal distance from the central femoral trochlea groove (TG)—the EP-TG distance. This fixed EP-TG distance, when considered together with the more variable (and therefore potentially misleading) TT-TG distance and patella height, provides a strong basis for surgical decision-making with regard to anteromedial tibial tubercle transfer planning.
Patellofemoral instability is a common knee pathology affecting children and adolescents, with recurrence rates exceeding 50% in skeletally immature patients. Identification and stratification of anatomic risk factors for recurrence are essential. Trochlear dysplasia, patella alta, skeletal immaturity, and elevated tibial tubercle groove distance have been identified as anatomic predictors of recurrence. Emerging evidence is supporting more aggressive treatment and earlier surgical intervention in high-risk patients, even after a first-time dislocation. Medial patellofemoral ligament reconstruction remains the cornerstone of surgical treatment for this population, with physeal sparing techniques for skeletally immature patients. Concomitant distal realignment procedures may be indicated in selected patients. This review synthesizes the current and latest evidence on predisposing anatomic risk factors, surgical techniques, and outcomes to guide clinical decision-making in the management of pediatric patellofemoral instability.
Recurrent patellofemoral instability (PFJI) can result in significant pain, functional limitations, and surgical failure. A thorough understanding of the reasons for such failures is crucial for developing effective revision strategies. This article offers a comprehensive guide to diagnosing and managing failed patellofemoral stabilization surgery, highlighting the multifactorial nature of PFJI and the importance of avoiding a “one-size-fits-all” approach. It explores common pitfalls, including over-reliance on unreliable metrics and technical errors during ligament reconstruction. The paper details practical surgical techniques, such as medial patellofemoral ligament (MPFL), medial patellotibial ligament (MPTL), and medial quadriceps tendon-femoral ligament (MQTFL) reconstruction, and outlines key considerations for tibial tubercle osteotomy and trochleoplasty. A structured diagnostic pathway is proposed to help identify the root cause of surgical failure and ensure a tailored approach to revision.
Recurrent patellofemoral instability is a common and disabling condition, particularly among young, active individuals. The medial patellofemoral ligament (MPFL) is a critical stabilizer of the patella, and its reconstruction has become a widely accepted surgical option following failed conservative treatment. While outcomes are generally favorable, significant variation persists in surgical techniques, patient selection criteria, and postoperative rehabilitation protocols. Furthermore, debates persist around the optimal graft choice, tunnel positioning, and the role of adjunctive bony procedures. This review explores the current approaches to MPFL reconstruction, summarises clinical outcomes, and discusses key controversies in the field. Improved standardization in technique, outcome reporting, and patient stratification is essential to refine treatment algorithms and optimize results.
Patellofemoral instability is a spectrum of disorders in which the patella loses normal tracking within the trochlear groove, presenting as subluxation or dislocation. Accurate quantification is essential for guiding treatment, yet no unified clinical and imaging scoring system exists. Patient-reported outcome measures remain inconsistent, with frequent reliance on general knee scores rather than tools specifically designed for patellofemoral instability. Imaging assessment requires multiple parameters, including patellar height, tibial tuberosity-trochlear groove distance, and trochlear morphology, but these are limited by static measurement and interobserver variability. This review examines current challenges in the diagnosis and management of patellofemoral instability and also highlights how artificial intelligence and machine learning models may support clinicians by improving diagnostic accuracy, risk stratification, and personalized treatment strategies.
Femoral anteversion is an important anatomic risk factor for patellofemoral instability. History and physical exam, in addition to diagnostic imaging, are all components of a full assessment to determine whether femoral anteversion is a significant contributor to a patient’s patellofemoral symptomatology. When appropriate, derotational femoral osteotomies can address rotational malalignment and improve patient outcomes. While distal femoral osteotomies have most commonly been associated with femoral derotation, each level of correction has its own advantages and may be more suitable, depending on the location of greatest deformity.
This study aimed to evaluate training workload and injury history in specifically professional roundnet athletes. An anonymous survey regarding players' injuries specific to roundnet was created with input from two premier roundnet athletes and two orthopedic surgeons. The 56 Spikeball Tour Series professional roundnet athletes from the 2023 season were contacted after the 2023 season to complete an anonymous injury history survey. Overall, 49 (88%) of the 56 professional roundnet athletes from the 2023 season were included in the study. Professional roundnet athletes had been competing in roundnet for a mean of 4 years and train 9.5 months per year. Players reported 82 roundnet injuries comprised of 43 (52%) upper extremity injuries, 24 (29%) lower extremity injuries, and 15 (18%) axial injuries. No reported injuries required surgical treatment. Upper extremity, lower extremity, and axial injuries had an average time to return to sport (RTS) of 1.8 months, 2.8 months, and 2.2 months missed, respectively. In conclusion, the upper extremity is the most commonly injured region in professional roundnet athletes, accounting for about half of roundnet injuries. Professional roundnet athletes most frequently experience significant acute injuries of the elbow and ankle, and significant chronic injuries of the shoulder and lower back.
Bodyweight exercises and weightlifting are foundational to strength training, yet their relative public health burdens remain poorly defined in large, nationally representative samples. We analyzed data from the National Electronic Injury Surveillance System from 2014 to 2023. A standardized keyword screening protocol was utilized to identify cases of weightlifting and bodyweight injuries treated in US emergency departments. Variance estimation was performed using Taylor series linearization to account for the complex, stratified sampling design and generate nationally representative estimates. Over the 10-year study period, national estimates of 546,655 weightlifting-related injuries and 108,001 bodyweight-related injuries were identified. Weightlifting injuries primarily involved the trunk (70.1%) and phalanges (13.7%). Bodyweight injuries were significantly associated with upper and lower extremity trauma (20.7%) and joint dislocations (8.7%). After adjusting for age and sex in a cluster-robust multivariable model, exercise modality was not a significant predictor of inpatient hospitalization (adjusted odds ratio: 0.91; 95% confidence interval: 0.60-1.38; p =0.666). While weightlifting poses a higher absolute volume burden, there is no significant difference in hospitalization odds when adjusting for age and sex. Prevention should focus on a suitable technique for heavy lifts and safe joint positioning for dynamic bodyweight movements, with increased diagnostic precaution and safety monitoring recommended for older participants.
Heat strain in multiple sclerosis patients during exercise limits their benefits from this treatment. One prior study examined this topic but did not measure thermal outcomes and constitutes a knowledge gap. The current pilot study assessed palm cooling for its impact on heart rates and thermal measures. Using a randomized within-subjects design, nine multiple sclerosis patients performed two 25-minute cycle ergometry workouts against 65 and 45% of their Astrand-Rhyming-based workloads. Heart rates, thermal flux, palm and tympanic temperatures were examined using two-way analyses of variance with repeated measures per independent variable. To control the family-wise error rate, a Bonferroni correction was applied at a lower α level of 0.0024. Paired t -tests identified sources of significant inter-treatment and -time differences. Palm temperature, thermal flux, and heart rate had significant two-way interactions. Palm temperature ( η 2 p =0.39) and heart rate ( η 2 p =0.22) results were significantly higher for the no palm cooling treatment at multiple times during and after workouts. Yet, thermal flux ( η 2 p =0.39) was significantly higher due to palm cooling at multiple times during and after workouts. Higher thermal flux from palm cooling may have evoked lower heart rates. Palm cooling may represent a practical strategy to mitigate exercise-induced heat strain in individuals with multiple sclerosis.
Sports Medicine and Arthroscopy Review (SMAR) is pleased to introduce the first of a 2-part series on patellofemoral instability, guest edited by Drs Nicola Maffulli and John Fulkerson. This issue reflects the journal’s mission, as articulated by Editor-in-Chief Emeritus Dr W. Dil Cannon, to “assemble key articles under 1 cover that provide an in-depth analysis of an important current topic.” This collection includes invited reviews on Precision Custom-Guided Anteromedial Tibial Tubercle Transfer Surgery; Medial Patellofemoral Ligament Reconstruction: Current Techniques, Outcomes, and Controversies; Quantifying Patellofemoral Instability: Clinical Metrics, Imaging, and AI-Based Predictive Models; Failed Patellofemoral Instability Surgery: A Practical Guide to Diagnosis and Revision; Pediatric Patellofemoral Instability Surgery—Current Concepts; and Patellofemoral Joint Preservation: Cartilage Restoration, Unloading, and Avoiding Complications; and Femoral Rotation Osteotomy in Patellofemoral Instability Surgery. The SMAR Podcast, hosted by Dr Mikalyn DeFoor, is now available on iTunes, YouTube, Spotify, and the SMAR website, featuring interviews with contributing authors.
Neck injuries are a common and clinically significant concern in athletes, with presentations ranging from soft tissue strain to spinal cord injury. The cervical spine's unique anatomy and biomechanics enable high mobility but also increase susceptibility to trauma during contact and high-velocity sports. This review examines acute and chronic injuries, including stingers, dislocations, radiculopathy, and spondylosis, and emphasizes their mechanisms, clinical presentations, and diagnostic workup. Management strategies span a range of conservative and surgical options, with evidence supporting individualized rehabilitation and targeted interventions based on symptom severity and neurological involvement. The review also synthesizes the current literature on key decision points, such as helmet removal in the field and return-to-play criteria, and highlights the importance of radiographic stability and neurological recovery. A comprehensive understanding of these strategies is essential for optimizing athlete safety and outcomes.
With recent advancements and growing literature on the treatment of cervical spine disease in athlete populations, there are new paradigms for treatment, either operatively or nonoperatively, to optimize return to play (RTP) and outcomes while minimizing complications. Although conservative management is effective in many cases, high-level athletes with persistent symptoms may benefit from early surgical intervention. Anterior cervical discectomy and fusion and cervical disc arthroplasty (CDA) have shown high RTP rates, with CDA offering potential advantages in motion preservation and lower adjacent segment degeneration. Long-term outcomes and RTP guidelines remain highly individualized and under-investigated.
Although rare, sports-related spine injuries can result in devastating, life-altering consequences, with the cervical spine injury being the most common with potentially devastating consequences, including quadriplegia and immediate death from cardiopulmonary compromise. Sports remain a leading cause of spinal cord injury (SCI) in the first 3 decades of life. Early, appropriate on-field management is critical to prevent further harm and improve outcomes. This manuscript outlines current evidence-based best practices for sideline evaluation and management of athletes with suspected spine injuries. Assessing and managing airway, breathing, and circulation (ABCs) as needed, along with minimizing spinal motion, are critical components of effective on-field emergency management. Rapid and accurate injury severity assessment is essential to guide the appropriate emergency response. Thorough preplanning and training are also vital to ensuring effective on-field management. Numerous practical considerations such as criteria for immobilization, helmet and shoulder pad removal, and transfer techniques are discussed.
Low back pain (LBP) in the athlete is a common condition that warrants specialized care. Knowledge of the various biomechanical and sport-specific factors remains critical in identifying the underlying etiology of LBP. There are both intrinsic spine causes of LBP, including entities such as degenerative disk disease, spondylolysis, and lumbar disk herniation and extrinsic causes of LBP, most commonly musculotendinous pathology. Accurate diagnosis and timely treatment are critical to a full return to sport. Further, preventative measures must be used to preserve the longevity of the athlete and minimize the risk of recurring injuries.
We extend our sincere thanks to our Guest Editors, who are the editors for each issue, and Associate Editors for helping us build an outstanding library of content. These articles, written by acknowledged experts, cover key topics in orthopedic sports medicine and arthroscopy. To further our mission of delivering in-depth analysis on important topics, we are expanding into social media and podcasting to better engage our community of readers and authors. To maximize the impact of these platforms, we are introducing two new optional features: Visual Abstracts and Auditory Abstracts. These additions cater to different learning styles and broaden the reach of our content. While participation is voluntary, both features offer authors a unique opportunity to present their work in a more engaging and resonant format-benefiting both authors and readers through enhanced visibility and accessibility.
