Subtle foot and ankle injuries in athletes, including syndesmotic sprains, ligamentous Lisfranc injuries, osteochondral lesions of the talus, and proximal fifth metatarsal stress fractures, may be underestimated or misclassified on conventional imaging. This review summarizes the current role of weightbearing CT (WBCT) in their evaluation, focusing on quantitative parameters, recent technical advances, and their potential influence on clinical decision-making. Recent evidence has shifted WBCT from qualitative assessment toward reproducible three-dimensional quantification. Volumetric assessment and distance mapping improve characterization of syndesmotic instability, while external-rotation stress can reveal abnormalities not evident during neutral standing. In the midfoot, triplanar realignment and side-to-side comparison improve the reliability of Lisfranc measurements and support detection of subtle instability. Distance mapping permits reproducible quantification of osteochondral lesion surface area, depth, and volume and may improve consistency in surgical planning. WBCT has also characterized sport-specific alignment patterns and a morphologic and bone-density phenotype associated with proximal fifth metatarsal stress fractures. Semiautomated segmentation and deep-learning methods may further reduce observer dependence and analysis time. WBCT provides three-dimensional measurements under physiologic load that complement clinical examination and conventional imaging in selected athletic foot and ankle conditions. Its greatest current value lies in characterizing subtle instability, malalignment, and osseous morphology when these findings may alter treatment planning. However, most available evidence is retrospective and derived from symptomatic or injured cohorts. Prospective studies are needed to validate diagnostic thresholds, determine whether WBCT-derived parameters predict injury or outcomes, and define their role in routine athletic screening and return-to-sport decision-making.
Circumferential minimally invasive surgery (cMIS) for adult scoliosis has evolved over the past five years. Here, we review how advances in patient selection, operative technique, and technology have transformed the capabilities of cMIS for deformity. Early cMIS was constrained by a “corrective ceiling” that limited its use to flexible deformities. Patient selection has since grown more nuanced, incorporating surgical complexity, patient-specific factors, and the deformity itself rather than radiographic thresholds alone. Technique has changed in parallel, as correction is now distributed across multiple interbody levels with segmental release, performed through both anterior and lateral techniques. Workflow and technology have adapted as well: single-position prone transpsoas and lateral prepsoas approaches may reduce intraoperative repositioning, staging extends treatment to patients with greater deformity or frailty, and robotics and patient-specific implants improve the precision of planning and execution. These advances have been accompanied by data demonstrating improved patient-reported outcomes and spinopelvic alignment at lower morbidity in appropriately selected patients. With the safety and efficacy of cMIS established, the field continues to push its boundaries toward more challenging pathology, as illustrated by contemporary cases of severe multiplanar deformity and complex revision. The boundaries of cMIS have expanded considerably beyond the flexible, moderate deformities for which these techniques were initially developed. Careful patient selection remains essential, as not all deformities are amenable to minimally invasive correction. Nevertheless, advances in surgical technique, operative workflow, and patient-specific planning have enabled increasingly severe and complex deformities to be addressed while preserving the fundamental advantages of minimally invasive surgery.
Reverse total shoulder arthroplasty (rTSA) was designed for rotator cuff tear arthropathy but is now used in patients with an intact rotator cuff, most often for primary glenohumeral osteoarthritis (GHOA). This review examines the current evidence for rTSA in cuff-intact patients, focusing on the indications, functional outcomes, complications, implant design considerations and surgical technique. In matched cohorts and meta-analyses restricted to cuff-intact GHOA, rTSA and aTSA produce comparable pain relief, patient-reported outcomes, satisfaction, and overhead elevation. ATSA restores greater external and internal rotation, but this difference often falls below clinically important thresholds and narrows over time. RTSA generally has a lower overall complication and revision rate, with baseplate loosening as the leading though still rare reason for revision surgery. Instability, acromial and scapular spine stress fracture, and revision surgery rates are all lower when the rotator cuff is intact. Current studies on the cuff-intact population are limited to 10-year outcomes, with registry survivorship of rTSA for GHOA approximately 96.1
To provide an anatomy-based review of musculoskeletal ultrasound (US) in the evaluation of plantar hindfoot pain in athletes. This review summarizes normal sonographic anatomy, characteristic findings, diagnostic utility, and limitations for plantar fascia, heel fat pad, calcaneal, peripheral nerve, vascular, and foreign-body pathology. It also examines how US findings should be integrated with the history and physical examination in athletes. Recent studies support high-resolution, dynamic US as a useful imaging modality for plantar hindfoot pain. US enables real-time assessment, contralateral comparison, sonopalpation, and evaluation during dynamic maneuvers. Emerging literature has further characterized the layered structure and loading behavior of the heel fat pad, dynamic sonographic findings of fat pad fracture and subluxation, and assessment of peripheral nerve entrapment. Recent studies also demonstrate that plantar fascia, heel fat pad, and other hindfoot abnormalities are prevalent in asymptomatic athletes. Although sonographic abnormalities may be associated with future time-loss injury, their low positive predictive value limits their role as a screening tool. MRI remains important when evaluating suspected calcaneal stress injury, marrow pathology, or complex soft-tissue disease. US is an accessible and valuable modality for the assessment of plantar heel pain in athletes. A structured, symptom-driven examination may improve diagnostic precision and identify alternative or coexisting pathology. Sonographic findings should be correlated with symptom location, physical examination, and sonopalpatory pain, particularly because structural abnormalities are common in asymptomatic athletes.
Shoulder instability in pediatric and adolescent athletes is increasingly common and clinically complex due to early sport specialization and high-demand participation. This review aims to inform clinical decision-making by synthesizing contemporary evidence on injury patterns, diagnostic techniques, treatment options, and associated outcomes when faced with treating pediatric athletes. Unique anatomic and developmental features specific to the pediatric population including capsular elasticity, collagen composition, open physes, and evolving glenoid and humeral morphology contribute to age-specific injury patterns and influence treatment outcomes. Younger children more frequently sustain atypical soft-tissue lesions, while adolescents experience markedly higher recurrence risk with rates of 44–77
