Open Access Journal of Sports Medicine最新文献

Pre-participation screening (PPS) is a primary-prevention strategy used in competitive sports to identify athletes at risk for cardiac diseases that can present with malignant arrhythmias and sudden cardiac death (SCD). Although compelling evidence supports the ability of PPS to lower SCD rates among athletes, no universal protocol has been adopted. Over time, however, key elements have emerged as common denominators: medical history, physical examination, and a 12-lead electrocardiogram (ECG). Research on ECG interpretation continues to evolve in search of the most accurate criteria for detecting cardiac disease, yet significant challenges persist. A major difficulty is the overlap between physiological remodeling in well-trained hearts and early manifestations of cardiomyopathy. In addition, some subgroups (female athletes, master athletes, and pediatric athletes) remain underrepresented in current studies. To ensure broad and equitable implementation, PPS must be supported by public-health policies and recognized as cost-effective, with the expectation that early identification of at-risk individuals will ultimately reduce the burden of advanced treatments on healthcare systems. Achieving this goal requires improving the sensitivity and specificity of existing screening tools to minimize misdiagnosis and avoid unnecessary secondary investigations or unwarranted disqualification from competition. This review summarizes the current status of cardiac screening in athletes, highlights persistent challenges, and outlines future directions to enhance its effectiveness and long-term sustainability.

Objective: The best pediatric and adolescent athlete anterior cruciate ligament (ACL) injury management method remains unknown. This systematic narrative review examined ACL reconstruction (ACLR), ACL repair, and conservative brace, or rehabilitation-based therapeutic exercise interventions with a delayed ACLR option for pediatric and adolescent ACL injury management. The primary purpose was to compare failure rates, return to sport (RTS) rates, and perceived knee function.

Methods: The PubMed, ResearchGate, Google Scholar, Sage Journals, and OVID (Medline) databases were searched. The Modified Coleman Methodology Score (MCMS) assessed study methodological quality and bias risk.

Results: Fifty-six studies were included. Group 1 (ACLR) studies were published before Group 2 (ACL repair) or Group 3 (conservative brace, or rehabilitation-based therapeutic exercise intervention with a delayed ACLR option) studies (Group 1 = 2010.8 ± 9; Group 2 = 2015.9 ± 10; Group 3 = 2018.0 ± 4, p = 0.05). Group 2 displayed "good" quality (MCMS = 70.2 ± 7.9), while Group 1 (MCMS = 63.3 ± 6.8) and Group 3 (MCMS = 59.8 ± 6.4) displayed "fair" quality (p ≤ 0.03). Group 2 had more level 1 or 2 studies, and Group 1 had more level 4 studies (p = 0.007). Lysholm scores were similar (Group 1 = 94.4 ± 2.7, Group 2 = 92.1 ± 6.8, Group 3 = 95, p = 0.51). Group RTS rates were similar (Group 1 = 88.8 ± 14%, Group 2 = 94.1 ± 10%, Group 3 = 78.6 ± 21%; p = 0.22). Group 1 failure rates (7.4 ± 6.6%) were < Group 2 (17.0 ± 19%) (p = 0.02) and Group 3 (32.4 ± 18%) (p < 0.001).

Conclusion: Although ACLR had lower failure rates, neurocognitive, reactive strength, and psychological readiness assessments were underreported. The stronger methodological rigor for ACL repair studies was encouraging but long-term outcomes are lacking.

Inguinal-related pain and/or disruption involve the abdominal tendinous and fascial tissues that connect to the inguinal ligament and the pubic tubercle. Epidemiological studies show these issues comprise 5-20% of groin problems in male athletes but rarely occur in female athletes. In this narrative review, we aim to synthesize the current understanding, assessment and management strategies for inguinal-related pain and/or disruption in athletes. Although inguinal-related pain and/or disruption is less common than adductor-related problems, it is vital not to overlook it. While the condition is often referred to as "sports hernia" or "incipient hernia", it is now agreed that true hernias are rarely found in this context. Instead, these conditions are classified as muscle-tendon injuries, and our understanding of their pathology has evolved significantly over the past few decades. Key anatomical structures include the external and internal oblique muscles, transversus abdominis, rectus abdominis, inguinal ligament, fascia transversalis, conjoined tendon, and the inguinal canal, which contains important nerves and vessels. Clinically, inguinal-related groin pain is diagnosed from detailed history and physical examination. Consensus statements now clearly define inguinal-related groin pain and disruption providing a solid foundation for a clinical diagnosis. Pathological findings may include subtle abdominal wall deficiencies to more overt abdominal tears and overuse injuries and imaging may aid in establishing differential and more specific diagnoses. A standardized "one-size fits all" treatment algorithm does not exist; however, a multidisciplinary approach is essential. Collaboration among sports physiotherapists, sports medicine specialists, and experienced abdominal surgeons has proven effective, informed by data from randomized controlled trials. First-line treatment typically includes non-surgical strategies, such as targeted physical therapist-led rehabilitation and activity modification with a graded return to sports approach. If non-surgical approaches fail, laparoscopic repair techniques demonstrate higher success rates. Central to effective management is shared decision-making that weighs the athlete's goals, competition calendar, and overall health-status.

Background: Hip microinstability-subtle, symptomatic femoral head translation without dislocation-compromises the labral suction seal and accelerates chondrolabral wear. Clinical overlap with femoroacetabular impingement syndrome (FAIS) and borderline dysplasia delays recognition.

Purpose: To synthesize contemporary evidence on definitions, diagnosis, imaging, management, and outcomes in hip microinstability and to propose a phenotype-guided framework grounded in the labrum-capsule-ligamentum teres (LT) stability continuum.

Study design: Narrative review.

Methods: Peer-reviewed literature (2000-2025) focusing on biomechanical investigations, comparative cohorts, meta-analyses, and consensus statements on microinstability, hip capsular management, borderline dysplasia, and LT pathology.

Results: A four-pillar diagnostic approach improves accuracy. The Abduction-Hyperextension-External Rotation (AB-HEER) and Hyperextension-External Rotation (HEER) tests provide the highest single-test accuracy among exam maneuvers, whereas the prone instability test offers high specificity to rule in. The femoroepiphyseal acetabular roof (FEAR) index aids in risk stratification for borderline dysplasia but is position-sensitive. Arthroscopy with labral preservation and complete hip capsular closure improves patient-reported outcomes (PROs) and survivorship relative to non-closure. Iatrogenic cam over-resection can precipitate microinstability; femoral head-neck remplissage is a revision option to restore contour and sealing mechanics. In borderline dysplasia, both arthroscopy and periacetabular osteotomy (PAO) improve PROs when selection is phenotype-guided; PAO trends toward lower total hip arthroplasty (THA) conversion when undercoverage is the primary driver. Early postoperative circumduction is associated with lower rates of adhesion-related reoperation. Return-to-sport (RTS) decisions are criteria-based rather than time-based across successful programs.

Conclusion: A seal-first, close-second strategy, situated within a stability continuum, underpins contemporary care. Standardized definitions, objective laxity metrics, multicenter registries, and microinstability-specific rehabilitation/RTS batteries are needed to refine indications and improve durability; evidence specific to labral augmentation in microinstability remains limited.

Clinical relevance: Precise phenotyping and capsular stewardship reduce the risk of revision hip arthroscopy and conversion to total hip arthroplasty, inform sport-specific counseling, and align with joint-preservation goals in young, active patients.

Level of evidence: V (Narrative Review).

Purpose: To examine the health history, growth and maturation profiles, and current health status of youth triathletes prior to entry into a National Institute Network (NIN); and determine associations between growth, training load, and health problem severity to inform developmental training strategies.

Methods: Youth triathletes (ages 12-18) were monitored over one year. Data was collected on athletic health history, growth (height, weight, arm spam) and maturation (bone age (BA); peak height velocity (PHV), predicted adult height (PAH), PAH%). Over 10 weeks the Oslo Sports Trauma Research Centre questionnaire (OSTRC-H2 questionnaire), training load and rate of perceived exertion (RPE) were recorded across triathlon disciplines.

Results: Estimated PHV occurred later than population norms (Female 12.5 ± 0.7; Male 13.3 ± 0.6). Estimated BA exceeded chronological age (CA) in both sexes. Males showed higher height tempo (B = 0.09, PD = 0.85), and arm span tempo than females (B = 0.20, PD = 0.96). Higher maturity offset was associated with greater total health problem severity (B = 0.23, PD = 0.98), reflecting a 25% increase per 1-year in maturity offset, and males typically had higher total severity (B = 0.52, PD = 0.90). Illnesses (n = 22) exceeded injuries (n = 14) and resulted in more total time-loss (3 vs 2 weeks). Swimming had the highest training volume, 24% higher than the bike (B = -0.28, PD = 0.99) and 44% higher than the running (B = -0.58, PD = 1.00), although more lower limb injuries were reported.

Conclusion: Sex-based maturation differences in youth triathletes require tailored training; high illness and injury prevalence identify the need for growth monitoring and balanced training to support long term athlete performance progression.

Knee osteoarthritis (OA) is a common degenerative joint disease affecting approximately 22% of adults over the age of 40 and is a major contributor to pain and disability worldwide. Platelet-rich plasma (PRP) has gained attention as a biologic treatment for this pathology due to its potential in modulating inflammation. This narrative review evaluates the current evidence on PRP for knee OA, comparing its efficacy to hyaluronic acid (HA), corticosteroids, and bone marrow aspirate concentrate (BMAC). High-quality studies consistently demonstrate that PRP provides superior pain relief and functional improvement compared to HA and corticosteroids and offers comparable results to BMAC. PRP is effective across all Kellgren-Lawrence grades, with the greatest benefits seen in early to moderate OA. Three-injection regimens appear more effective than single injections, and while both leukocyte-rich and leukocyte-poor formulations are used, no clear consensus exists on which is superior. Despite promising short- and mid-term outcomes, variability in preparation methods and limited long-term evidence remain important limitations. Current literature suggests that PRP may be a safe and potentially effective nonoperative option for managing knee osteoarthritis, though further high-quality, standardized studies are needed to confirm its long-term efficacy and optimal application.

Exercise-associated hyponatremia (EAH) is an important cause of preventable morbidity and mortality. EAH refers to a low blood sodium concentration [Na⁺] of <135 mmol·L^-1, during or within 24 h of sustained endurance exercise. The current EAH literature contains ambiguities among field studies and unresolved clinical issues. Seeking clarity and resolution, we conducted manual searches of two large electronic databases using pre-defined inclusion criteria and discovered 1516 article titles and abstracts. Subsequent reviews of 345 full-length articles identified 56 eligible field research studies that reported 220 EAH cases during seven outdoor endurance activities (5-29.5 h duration). Our evaluations of these EAH cases generated the following seven findings. First, a greater percentage, not the absolute number, of women experienced EAH than men. Second, event specificity may account for much of the wide range of EAH symptoms and signs (SAS) reported among different outdoor activities. Third, out of 220 reported cases of EAH, none were asymptomatic when [Na⁺] was <130 mmol·L^-1. Fourth, the absolute value of [Na⁺] is not a reliable predictive index of EAH clinical severity or presentation. Fifth, running or hiking resulted in far more EAH cases and published epidemiological studies than cycling, swimming, and triathlon events. Sixth, the most common mild EAH complaints were nausea, weakness or lethargy, dizziness, headache, and extremity swelling. Seventh, the most common SAS of moderate-to-severe EAH (ie, suggesting hyponatremic encephalopathy) included altered mental status, vomiting, seizure, agitation/restlessness, collapse, and loss of consciousness. In conclusion, these findings should inform pre-event medical planning, on-site medical staff briefings, as well as the diagnosis of EAH severity in field settings. We also propose that our inventory of position statements and consensus documents will meet the needs of athletes and coaches who seek dependable information regarding risk factors and prevention.

Introduction: Bone mineral density (BMD) from dual-energy x-ray absorptiometry (DXA) provides bone health information. BMD monitoring in collegiate athletes may be beneficial for performance and overall bone health. Currently, there is limited information regarding BMD among female Division I athletes, with no studies tracking pre- to postseason dominant and non-dominant limb BMD in this demographic. The purpose of this study was to assess changes in lower limb BMD in this population from pre- to postseason.

Methods: Sixty-four participants (field hockey, soccer, and volleyball) were included in this analysis. Preseason DXA scans were completed before the start of the athletic season and postseason was on average collected 126.5 ± 13.4 days after. A full-body DXA scan was completed, and dominant and non-dominant lower limb BMD values were utilized in the statistical analysis. A 2×2 ANCOVA was conducted with sport type set as a covariate.

Results: Preseason (age: 20.4±1.56 years, height: 168.0±7.2 cm, weight: 66.0±9.4 kg) lower limb BMD was not significantly different from postseason. The interaction between time and limb (F₁,₆₁=0.09, p=0.76) was not significant. No significant main effects were seen for time (F₁,₆₁ =0.80, p=0.38). There was a significant main effect for limb (F₁,₆₁=4.45, p=0.04).

Conclusion: No significant changes were seen in lower limb BMD from pre- to postseason in female athletes, a significant difference was observed between the dominant and non-dominant limb. BMD monitoring is important to preserve bone health and future research should explore BMD changes over multiple seasons to assess potential sport-specific or cumulative effects.

Rotator cuff pathology is present in nearly half the adult population over the age of 50 years and remains a leading cause of shoulder pain and dysfunction. These musculotendinous injuries may be the result of an acute trauma or chronic degeneration. Clinical examination involves inspection, range of motion, and strength assessment with special testing used to isolate the involved rotator cuff muscles. The classification of these injuries involves identification of tear size, thickness, morphology, and the presence of tendon retraction or muscular atrophy to guide clinical management. Magnetic resonance imaging is the primary imaging modality used to define these metrics unless contraindicated in select patients. Nonoperative management is largely reserved for partial thickness tears involving <1 cm full thickness tears. Surgical repair is indicated in the symptomatic patient with >25% of bursal or >50% articular surface involvement and those >1 cm in the sagittal plane. These are often managed with primary repair using single row, double row or transosseous equivalent techniques. In the event of irreparable rotator cuff tears with significant tendon retraction with or without fatty atrophy, partial repair techniques with augmentation, superior capsular reconstruction, and balloon spacers remain salvage options prior to consideration of reverse shoulder arthroplasty. Additionally, there remains debate on optimal postoperative rehabilitation protocol with recent literature supporting early passive mobilization and active range of motion at four to six weeks without compromise of tendon repair integrity that could serve to optimize both glenohumeral motion, accelerated recovery and strength optimization without an increase in re-tear rates. There is currently a lack of high-quality, long-term studies directly comparing surgical techniques and nonsurgical management, especially with follow-up beyond five years to assess durability, re-tear rates, and functional outcomes. This review aims to critically appraise the available evidence to guide optimal rotator cuff repair techniques and postoperative rehabilitation protocols.

Knee dislocations (KD) and multiligamentous knee injuries (MLKI) are challenging injuries to manage due to the high incidence of associated neurovascular compromise, extensive peri-articular soft-tissue trauma, and long-term functional deficits. Knee-spanning external fixation (KSEF) is occasionally utilized in the acute management of these injuries with the aim of maintaining alignment, protecting vascular repairs, allowing soft-tissue recovery prior to definitive treatment, and protecting freshly reconstructed or repaired ligaments. Despite its use in 5% of MLKIs and up to 50% of KDs, the clinical indications, outcomes, and complications associated with KSEF in the setting of KD/MLKI remain incompletely defined. Furthermore, KD/MLKI treatment algorithms incorporating decision-making related to KSEF application are limited both institutionally and within the literature. Thus, the purpose of this study was to consolidate the existing evidence related to the use of KSEF in the setting of KD/MLKI to support clinical decision-making and identify avenues for future investigation. Following a narrative review of the literature, the identified indications for KSEF in the setting of KD/MLKI were vascular injury, knee fracture-dislocation, extensive soft-tissue injury, persistent instability following reduction, open KDs, and when bracing is not feasible due to patient factors such as morbid obesity. Both rigid and hinged KSEF constructs have been described, with hinged fixators potentially permitting early motion while providing joint stability. Reported complications of KSEF include arthrofibrosis, infection, heterotopic ossification, and compartment syndrome, though available data are primarily retrospective and heterogeneous. Other topics that have been addressed in the literature include biomechanics, cost, magnetic resonance imaging (MRI) compatibility, and psychological impact. However, further research is needed to clarify its specific role, define standardized indications, and compare outcomes with non-invasive or alternative fixation and immobilization strategies.