To describe the mechanisms, situational patterns, biomechanics and neurocognitive errors related ankle sprain injuries of professional male football players during match play.
There were 166 consecutive ankle sprain injuries identified occurring during official matches in players of top European football leagues. One hundred and forty (84%) injury videos were analysed for mechanism and situational pattern, with biomechanics on 20 players. Neurocognitive errors were investigated for all noncontact injuries. Three independent reviewers evaluated each video. Ankle sprain injury epidemiology—month, timing within the match and pitch location at the time of injury and time-loss according to sprain type was also documented.
More injuries occurred in offensive (n = 89, 64%) than defensive (n = 51, 36%) situations (p < 0.001). Seventy (50%) direct contact, 42 (30%) indirect contact and 28 (20%) noncontact injuries were categorised. There were 67 (48%) inversion, 30 (21%) high ankle, 25 (17%) eversion, 6 with combination of high ankle and eversion (4%) and 12 (9%) unsure injuries. Four main situational patterns were described: (i) being tackled (n = 59, 42%); (ii) tackling/pressing (n = 34, 24%); (iii) landing from a jump (n = 16, 11%) and (iv) sliding (n = 7, 5%). Inversion injuries were associated with internal rotation, while high ankle injuries typically involved toe contact with the ground, slight plantar flexion and foot eversion. A neurocognitive error was documented 59% of noncontact injuries. A similar number of injuries occurred during the 1st (n = 71, 51%) and 2nd (n = 69, 49%) half (p > 0.05).
Half of ankle sprain injuries occurred after direct contact, 3 in 10 after indirect contact and only 2 in 10 without contact. Injury prevention practices should consider mechanical perturbation, playing situation and neurocognitive factors when designing programmes.
Level IV.
The purpose of the study was to identify the safety and effectiveness of an accelerated (AR) versus conservative (CR) rehabilitation regimen following surgical repair of proximal hamstring tendon avulsions.
This prospective randomized controlled trial (RCT) allocated patients undergoing proximal hamstring tendon repair to either a braced, partial weight-bearing rehabilitation regime (CR = 30) or an accelerated, unbraced regime, which permitted full weight-bearing as tolerated (AR = 27). Patients were evaluated pre-operatively and at 6 weeks, 3 and 6 months post-surgery, via patient-reported outcome measures (PROMs), patient satisfaction and global rating of change (GRC) scores. Objective measures, including the single (SHD), triple (THD) and triple crossover (TCHD) hop tests, were assessed at 6 months, as was peak isokinetic knee extensor and flexor torque.
Of the 57 patients recruited, 4 were excluded from the CR group (2 infections; 2 re-injuries). The CR group contained 57% males with a mean age of 45.6 (standard deviation [SD] = 13.4). The AR group contained 44% males with a mean age of 50.5 (SD = 11.8). Therefore, 53 patients (CR = 26, AR = 27) were reviewed at the final 6-month follow-up. Within-group analyses showed that both groups significantly improved in all PROMs (p < 0.05). No significant differences were observed between groups for satisfaction, GRC scores, knee extensor torque, knee flexor torque, limb symmetry indices, re-injuries or complications at 6 months.
This RCT has highlighted the safety and efficacy of a post-operative rehabilitation pathway that includes weight-bearing as tolerated, without bracing, in patients after proximal hamstring tendon repair.
Level I.
This study aimed to compare clinical outcomes between open and arthroscopic anterior latissimus dorsi (LD) transfer techniques for treating irreparable subscapularis (SSC) tears.
We retrospectively reviewed patients who underwent open or arthroscopic anterior LD transfer for irreparable SSC tears between February 2014 and August 2020. Patients were included if they had irreparable SSC tears with Lafosse Grade 4 or higher and Goutallier Grade 3 or higher, but without advanced arthritis (Hamada Grade < 3). Clinical assessments involved pain scores (visual analogue scale, VAS), patient-reported scores (Constant score and subjective shoulder value [SSV]), range of motion (ROM) and internal rotation (IR) strength. Any complications, integrity of the transferred tendon and progression of glenohumeral arthritis were evaluated. Patients were excluded from the study if they lacked follow-up data or were lost to follow-up.
After excluding 28 patients, a total of 86 patients were included (34 arthroscopic and 52 open technique). The mean age was 63.5 ± 7.1 years, and the mean follow-up was 36.2 ± 14.9 months. Significant improvements were observed in pain (VAS from 7.2 ± 1.2 to 1.1 ± 1.5, p < 0.001), Constant score (from 29.1 ± 8.8 to 69.0 ± 12.6, p < 0.001) and SSV (from 24.3 ± 9.6 to 65.5 ± 15.7, p < 0.001). Shoulder ROM and IR strength also improved significantly. Both techniques showed comparable clinical outcomes, although the open technique group demonstrated greater gains in IR strength (p = 0.015). Complications included retear in 8.1% of patients and infection in 7%, with no significant differences between the two techniques.
Both open and arthroscopic anterior LD transfer techniques effectively reduce pain, improve shoulder function and enhance IR strength in patients with irreparable SSC tears, with comparable clinical outcomes and minimal complications.
Level III, retrospective comparative case series.
The purposes of this study were threefold: (1) to evaluate the influence of femoral antecurvature on coronal alignment changes following supracondylar femoral derotational osteotomy (FDO); (2) to investigate the combined effects of derotation angle and osteotomy orientation in relation to femoral antecurvature and (3) to propose a practical strategy for minimising valgus deviation after FDO based sagittal femoral bowing.
Sixty-six cadaveric femoral computed tomography (CT) scans were analysed using three-dimensional (3D) simulation. Femurs were classified into three groups based on the degree of antecurvature using the distal diaphyseal angle (DDA). Virtual surgery was simulated at 7 cm above the joint line using two osteotomy methods (shaft-perpendicular and distal femur condylar line [DFC]-parallel) and two derotation angles (10° and 20°). Mechanical lateral distal femoral angle (mLDFA) was measured before and after simulation. Multivariable and stratified regression analyses were performed.
Greater antecurvature led to larger mLDFA decrease, with more pronounced valgus shifts at higher derotation angles. Making DFC-parallel osteotomy significantly reduced valgus change regardless of bowing (β = −0.331, p = 0.005). A significant interaction was found between DDA and derotation angle (β = 0.015, p < 0.001). The combination of DFC-parallel osteotomy with 10° derotation provided the least valgus change (R² = 0.84). The allowable derotation angle to maintain <1° valgus shift decreased as DDA increased.
Femoral antecurvature significantly affects coronal alignment after supracondylar FDO. Although the optimal target angle for derotation remains a surgical choice, understanding the relationship between sagittal bowing and coronal alignment can help tailor patient-specific decisions. To minimise valgus shift after supracondylar FDO, aligning the osteotomy plane parallel to the distal femur condylar line can be effective. This method is simple and practical for standard surgical procedures.
Level IV.
Despite undisputed success of orthopaedic procedures, surgical site infections (SSI) such as periprosthetic joint infection (PJI) continues to compromise the outcome and result in major clinical and economic burden. The overall rate of infection is expected to rise in the future resulting in significant associated mortality and morbidity. Traditional concepts have largely attributed the source of PJI to exogenous pathogens. However, recent studies indicate that pathogens from the patient's own microbiome, colonizing the skin, nasal passages, gut microbiota, and even the surgical site play a major role in causing SSIs. Immune cell-mediated ‘Trojan Horse’ pathways have been posited as the mechanism of how bacteria reach and persist at the surgical site. In light of these developing insights, novel therapeutic strategies are under investigation. Some exciting developments include the use of membrane-permeable antibiotics, bacteriophage therapy targeting intracellular pathogens as well as probiotics, prebiotics or faecal microbiota transplantation. Overall, targeting the endogenous microbiome represents a promising frontier for improving the prevention and management of PJI in the era of rapidly increasing total joint arthroplasty procedures.
Orthopaedic trials frequently rely on patient-reported outcomes (PROs) to measure primary end points. Thresholds for clinically meaningful score differences are then used to interpret PRO scores and support result interpretation. At the patient level, thresholds are used to determine if an individual patient has experienced a clinically meaningful improvement or deterioration, which evaluates whether or not they are a treatment responder. At the group level, thresholds are applied to interpret mean score differences between groups (e.g., trial arms) or between time points and determine if a treatment effect is meaningful. While patient-level thresholds are frequently available for commonly used PROs, interpretation of between-group-level differences is far less established. In the absence of well-defined group-level difference thresholds for PRO scores, patient-level thresholds are frequently used to interpret the difference between groups, such as trial arms. However, meaningful difference thresholds at the patient level are typically larger than relevant differences at the group level. As such, this leads to an underestimation of treatment effects reported in orthopaedic trials.
Scapular dyskinesis (SD) is present in as many as 67%–100% of athletes with shoulder injuries but it is also highly present in many asymptomatic individuals. The aim of the present study was to identify and analyse SD among asymptomatic professional basketball players.
A total of 54 European professional basketball players of various professional levels and ages were included in this prospectively recruited cross-sectional study. Participants were assessed using subjective shoulder value (SSV), visual analogue score (VAS) and active range of motion (ROM). Visual combined palpation was used to classify scapular position and movement patterns according to Kibler's method. The clinical examination was completed by evaluating potential coexisting instability (apprehension test, Kim/Jerk and O'Brien tests) and hyperlaxity (Beighton score).
The mean age of all participants (27 female, 27 male; 108 shoulders) was 23.9 ± 6.5 years. 28.7% of the included shoulders had SD (31/108; right: n = 12; left: n = 19), while none of the participants had a diagnosed SD before the present study. Shoulders with SD exhibited a significantly lower SSV (95.0 ± 10.5% vs. 99.0 ± 4.0%; p = 0.004) and reduced abduction (171.8 ± 11.7° vs. 176.6 ± 8.3°, p = 0.013) compared to shoulders without SD. Shoulders with at least one previous injury showed a significantly lower SSV compared to shoulders without previous injury (92.9 ± 12.0% vs. 98.4 ± 5.6%; p = 0.001). Shoulders with pain occurring at least once in last 12 months showed a significantly higher prevalence of SD (6/10 vs. 25/98; p = 0.022) and a lower SSV (90.5 ± 16.4% vs. 98.6 ± 4.4%; p = 0.024) compared to shoulders without pain in last 12 months.
SD was observed in 28.7% of the shoulders in asymptomatic European professional basketball players. SD may represent a sport-specific adaptation, but its association with reduced shoulder function and pain suggests clinical relevance, emphasising the need for early detection and intervention.
Level III, cohort study.
Dutaillis B, Collings T, Bellinger P, Timmins RG, Williams MD, Bourne MN. Time-course changes in lower limb strength, vertical jump metrics and their relationship with patient reported outcomes following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2025;33(7):2684–2699. https://doi.org/10.1002/ksa.12694
The conflict-of-interest statement has been updated to declare potential perceived conflicts of interest for authors Matthew Bourne and Morgan Williams:
“Associate Professor Matthew Bourne is supported by an Advance Queensland Industry Research Fellowship in partnership with VALD. Dr. Morgan Williams is an employee of VALD.”
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