Search Results (560)

Background/Objectives: Subtalar arthroereisis (STA) is widely used for symptomatic pediatric flexible flatfoot and provides consistent radiographic correction. However, return to sport (RTS) after STA is less well defined, and the relative role of early postoperative pain versus radiographic correction remains unclear. Methods: We performed a retrospective observational cohort study of consecutive skeletally immature patients treated with STA using a non-absorbable endosinotarsal screw at a single tertiary center. Inclusion criteria were symptomatic flexible flatfoot refractory to >6 months of conservative treatment, complete pre-/postoperative weight-bearing radiographs, complete functional data, and minimum follow-up of 6 months. The primary endpoint was RTS to the pre-symptom primary sport at final follow-up. Secondary outcomes were UCLA Activity Score, FAAM Sport subscale, and postoperative VAS. Radiographic correction was quantified as delta change (Δ) in Meary, Costa–Bertani, and Kite angles. Group comparisons used nonparametric tests. A parsimonious multivariable logistic regression model (EPV-constrained) included UCLA at 3 months, VAS pain, and ΔMeary. Results: Fifty patients were included (mean follow-up 9.2 ± 2.5 months; range 6–14); 27/50 (54%) resumed their primary sport. Baseline characteristics were comparable between Returners and Non-Returners. Returners showed higher early postoperative UCLA scores than Non-Returners (8.0 [7.0–8.5] vs. 6.0 [5.0–7.0], p = 0.005). FAAM Sport and VAS pain did not differ significantly between groups (p = 0.224 and p = 0.493, respectively). Radiographic correction magnitude was similar between groups (ΔMeary p = 0.938; ΔCosta–Bertani p = 0.984; ΔKite p = 0.108). In multivariable analysis, UCLA at 3 months was the only independent correlate of RTS (OR 2.65 per point, 95% CI 1.34–6.15; p = 0.009), whereas VAS pain (OR 0.98, 95% CI 0.76–1.25; p = 0.892) and ΔMeary (OR 1.01, 95% CI 0.91–1.13; p = 0.875) were not significant. Conclusions: In this cohort, STA achieved substantial radiographic correction, but neither correction magnitude nor early postoperative pain independently correlated with RTS at short-term follow-up. Early postoperative activity level was the strongest independent correlate of sport resumption, supporting a function-centered postoperative assessment beyond radiographic alignment alone. Full article

Background: Shoulder injury is common among athletes who engage in sports where the upper limb is actively involved. These injuries can affect an athlete’s performance and ability to return to sports at the preinjury level. This study aimed to cross-culturally adapt the Subjective Patient Outcome for Return to Sports score in Greek (SPORTS-GR) and evaluate its reliability and construct validity. Methods: Sixty-five Greek athletes (18–40 years) diagnosed with shoulder pathology were included. The SPORTS-GR was adapted according to standard procedures, and its construct validity was examined via associations with the Shoulder Pain and Disability Index (SPADI-GR) questionnaire, which assesses pain and disability related to shoulder pathologies. Test–retest reliability was tested by repeating the SPORTS score questionnaire administration after 6–8 days. Eligible athletes were selected from the Hellenic Supreme Council of Military Sports. Results: Face validity was excellent with a ceiling effect of 35.4%. The construct validity was high, with strong negative correlations between the SPORTS-GR score and the SPADI-GR total score (r = −0.91, p < 0.001), pain subscale score (r = −0.84, p < 0.001), disability subscale score (r = −0.90, p < 0.001), and age (r = 0.26, p = 0.04). Test–retest reliability was also excellent (ICC = 0.98) with no significant systematic error (SEM = 0.09). Conclusions: The SPORTS-GR is valid and reliable for evaluating athletes’ return to sports with shoulder pathologies. Full article

Background/Objectives: Psychological barriers, particularly kinesiophobia and diminished psychological readiness, represent critical yet undertreated obstacles to a successful return to sport following anterior cruciate ligament reconstruction (ACLR). Scalable, preference-aligned educational interventions capable of addressing these barriers during early rehabilitation are lacking. We aimed to evaluate the effectiveness of structured educational content delivered via Snapchat, as an adjunct to standard ACLR rehabilitation, in reducing kinesiophobia (primary outcome) and improving psychological readiness and perceived knee function (secondary outcomes). Methods: A total of 120 adults with clinically elevated kinesiophobia (TSK-17 > 37) undergoing post-operative ACLR rehabilitation were enrolled in a quasi-experimental, two-arm study with non-randomized allocation at the clinic-branch level at two branches of the same sports rehabilitation clinic (Joint Clinics, Riyadh, Saudi Arabia). Branch allocation assigned 60 participants to each group (intervention and control). The intervention group received 12 weekly structured educational videos via Snapchat alongside standard rehabilitation; the control group received standard rehabilitation alongside general ACLR information videos via Snapchat. TSK-17, ACL-RSI, and IKDC were assessed at baseline and at 12 weeks. Primary analysis used ANCOVA covarying baseline scores, complemented by mixed repeated measures ANOVA and intent-to-treat analysis. Results: Both groups improved across all outcomes; the intervention group demonstrated significantly greater gains. ANCOVA revealed significant between-group differences favoring the intervention for TSK-17 (adjusted mean difference = −2.82; d = 0.54; p < 0.001; d represents Cohen’s d calculated from adjusted mean differences and pooled SD), ACL-RSI (+8.06; d = 0.77; p < 0.001), and IKDC (+8.90; d = 0.54; p = 0.002). Mean video completion was 82.8% among intervention participants. Intent-to-treat analyses using Multiple Imputation confirmed all findings. Conclusions: Snapchat-based structured education was associated with improvements in kinesiophobia, psychological readiness, and perceived knee function among the 102 analyzed participants (control n = 52; intervention n = 50) of the 120 enrolled. High engagement supports preference-based digital delivery as a scalable adjunct to standard rehabilitation. Full article

Background and Objectives: The assessment of neuromuscular recovery after ACL reconstruction is crucial for safe return to sport (RTS) in professional soccer players. This retrospective cross-sectional study aimed to compare squat jump (SJ), bilateral countermovement jump (CMJ), and single-leg CMJ performance in three distinct groups: players at 6 months post-ACL reconstruction, players at 9 months post-ACL reconstruction, and healthy controls. Materials and Methods: Seventy-two male players (24 at 6 months post-ACL, 24 at 9 months post-ACL, 24 healthy controls) performed squat jump, bilateral countermovement jump, and single-leg CMJ tests using contact platforms following a controlled warm-up protocol. Results: Significant group differences were observed in all jump tests. At 6 months post-ACL reconstruction, players demonstrated significantly lower squat jump (45.13 ± 6.20 cm) and bilateral countermovement jump (49.67 ± 6.80 cm) heights compared to both 9-month players (SJ: 50.03 ± 5.30 cm; CMJ: 53.79 ± 4.85 cm) and controls (SJ: 51.12 ± 4.97 cm; CMJ: 55.49 ± 5.54 cm) (p ≤ 0.016, η² = 0.187 and η² = 0.156, respectively). No significant differences between 9-month and control groups were observed for the squat jump and the bilateral countermovement jump. Regarding the unilateral countermovement jump, the injured leg showed significant performance deficits compared to controls in both the 6-month and 9-month groups (p = 0.001, η² = 0.378). However, the non-injured leg exhibited deficits only in the 6-month group. Conclusions: Compared to the 6-month post-ACL reconstruction group, the 9-month group showed a marked improvement in bilateral jump performance, indicating substantial neuromuscular recovery over time. However, persistent unilateral deficits in the injured leg remained even at 9 months, underscoring the need for a routine and comprehensive jumping evaluation to identify residual neuromuscular impairments that may require targeted rehabilitation before returning to sport. Full article

Background: Psychological determinants are increasingly recognized as central contributors to both performance decline and recovery in competitive sport; however, contemporary evidence integrating injury-related and non-injury performance contexts remains fragmented. Objective: This systematic review synthesized empirical evidence (2016–2025) examining psychological determinants associated with return to sport (RTS), reinjury risk, burnout, injury incidence, and performance decline among competitive athletes. Methods: Conducted in accordance with PRISMA 2020 guidelines, a systematic search of PubMed, Scopus, Web of Science, and SPORTDiscus identified peer-reviewed studies published between January 2016 and December 2025. Eligibility criteria were defined using a PICO framework. Prospective cohort studies, longitudinal multi-wave investigations, one randomized controlled trial, matched cohort studies, diary-based designs, and injury-related observational studies were included. Due to heterogeneity in constructs and outcomes, findings were synthesized narratively. Results: Fourteen studies met the inclusion criteria, including prospective cohort studies, multi-wave longitudinal designs, one randomized controlled trial, one matched cohort study, and a diary-based investigation. Seven independent cohorts examined psychological readiness using the Anterior Cruciate Ligament—Return to Sport after Injury scale (ACL-RSI) in athletes with anterior cruciate ligament (ACL) injuries (sample sizes ranging from n = 39 to n = 384), consistently demonstrating that higher readiness predicted successful RTS at 6–24 months, while two prospective studies reported contrasting associations with second ACL injury risk. Four longitudinal studies (n = 93–491) showed that increased burnout and controlled motivation predicted performance decline and dropout trajectories, whereas higher resilience and mental toughness reduced burnout progression. One seasonal longitudinal study (n = 21) linked elevated cognitive anxiety and mood disturbance to increased injury incidence. Conclusion: Psychological determinants operate across deterioration and restoration pathways. Psychological readiness shows the strongest predictive consistency for RTS, while burnout, motivational climate, and resilience significantly shape long-term performance sustainability and injury-related outcomes. Full article

Background: Calcaneus secundarius (CS) is an accessory ossicle located at the anterior aspect of the calcaneus and is typically an incidental and asymptomatic radiographic finding. However, it may become symptomatic following trauma or repetitive mechanical stress and can mimic anterior calcaneal process fracture or tarsal coalition, leading to diagnostic confusion. The presence of multiple independent CS ossicles represents a rare morphological variant and a potential source of diagnostic ambiguity. Methods: We report the case of a 19-year-old male soldier who presented with progressive anterior foot pain following soccer activity without a clearly identifiable traumatic event. Radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) were performed to evaluate the underlying pathology. Results: CT demonstrated two separate, well-corticated accessory ossicles adjacent to the anterior calcaneal process without bony continuity. MRI revealed focal bone marrow edema (BME) at the calcaneus–ossicle interface, suggesting mechanical irritation at the fibrous connection. Due to persistent symptoms and concordant imaging findings, surgical excision was performed, resulting in immediate pain relief and return to full daily and sports activities without recurrence at the 1-year follow-up. Conclusions: Multiple CS ossicles may produce fragment-like imaging appearances and increase the risk of misdiagnosis. Recognition of characteristic imaging features, particularly well-corticated ossicles and focal BME at the ossicle–calcaneus interface, together with clinical correlation, is essential for accurate diagnosis and appropriate management in patients with persistent anterior foot pain. Full article

Stress fractures (SFs) are a common overuse injury in athletes and represent the severe end of the bone stress injury (BSI) continuum. They result from repetitive mechanical loading exceeding the bone’s capacity for adaptation and are associated with impaired performance, prolonged time away from sport, and risk of recurrence if not appropriately managed. This narrative review provides a clinically oriented synthesis of current evidence on the epidemiology, pathophysiology, risk factors, diagnosis, management, and prevention of SFs in athletes. Particular emphasis is placed on modifiable contributors, including training load errors, neuromuscular fatigue, and low energy availability within the framework of Relative Energy Deficiency in Sport (RED-S). Diagnostic evaluation is discussed using a stepwise clinical approach integrating history, physical examination, targeted laboratory assessment, and imaging, with magnetic resonance imaging (MRI) as the reference standard for early detection and severity grading. Management is presented through a risk-based framework combining MRI severity and anatomical site classification to guide treatment decisions and return-to-sport pathways. While most low-risk SFs respond to conservative strategies, high-risk lesions require closer monitoring and, in selected cases, early surgical consideration. This review proposes a practical clinical framework to support decision-making in athletes with suspected or confirmed SFs, aiming to improve early diagnosis, optimize management, and reduce recurrence risk in sports medicine practice. Full article

Background/Objectives: Objective, non-invasive biomarkers are needed to track anterior cruciate ligament (ACL) graft maturation and support individualized return-to-sport decisions. This study evaluated a single-session multiparametric quantitative MRI (qMRI) protocol for longitudinal assessment of ACL graft microstructural evolution and its association with patient-reported outcomes. Methods: Twenty-eight patients undergoing primary ACL reconstruction with hamstring autografts underwent multiparametric qMRI (T1, T2*, R2*, and PD mapping) at 1, 3, 6, and 12 months. The contralateral native ACL served as a within-subject control. IKDC, Lysholm, and VAS scores were recorded at each visit. Linear mixed-effects models were used to test longitudinal changes. Correlations of baseline-normalized changes between adjacent visits were used to evaluate imaging–clinical associations. Results: All qMRI parameters changed significantly over time (all p < 0.001). At 1 month, T1, PD, and T2* were lower and R2* higher than the contralateral native ACL (all p < 0.001). Thereafter, T1, PD, and T2* increased and R2* decreased, with most metrics approaching contralateral values by 3–6 months (all p < 0.05), and changes entered a plateau after 6 months (all p > 0.05). IKDC, Lysholm, and VAS improved over time (all p < 0.001), mainly before 6 months. Greater early T2* increases and R2* decreases (1–3 months) were associated with less pain relief and smaller Lysholm improvement (p < 0.05); no significant associations were observed from 6–12 months. Conclusions: Single-session multiparametric qMRI sensitively captures ACL graft maturation and highlights 3–6 months as a critical remodeling window, providing objective biomarkers to complement clinical assessment for individualized rehabilitation monitoring and return-to-sport timing. Full article

Out-of-school tutoring, as a form of privatized compensatory education beyond formal schooling, has become increasingly prevalent, yet its role in fostering students’ holistic competencies remains insufficiently examined. Drawing on a student engagement perspective, this study investigates how different types of out-of-school tutoring, including academic, arts, and sports tutoring, are associated with the development of students’ holistic competencies. Data were drawn from a survey of 704 Grade 10 students in central China. Tutoring engagement during junior secondary school was measured using a self-developed Likert-scale instrument, while holistic competencies were obtained from official Comprehensive Quality Assessment records. The findings reveal differentiated effects across tutoring types. Academic tutoring shows no significant association with academic performance or other dimensions of holistic competence. In contrast, sports tutoring is positively associated with physical and mental health, and arts tutoring demonstrates a significant positive relationship with artistic literacy. Regarding engagement characteristics, simply increasing the number of programs or financial investment yields limited benefits. Instead, time investment and cognitive involvement in sports tutoring, as well as affective involvement in arts tutoring, are positively related to specific dimensions of holistic competence. These results suggest that the effectiveness of out-of-school tutoring depends less on participation amount and more on the nature of students’ engagement. The study highlights the uneven developmental returns of compensatory education and calls for a more balanced and development-oriented approach to tutoring participation. Full article

Tennis is an exceptionally fast-paced sport where the ability to return the ball precisely to an opponent’s weak zones often determines match outcomes. Although wall practice serves as a fundamental and effective training method, accurately capturing and analyzing the spatial distribution of ball impact points during high-speed rallies remains highly challenging. Leveraging computer vision, we propose a two-stage detection pipeline that integrates You Only Look Once Version 12 and MobileNetV2 to generate candidate bounding boxes, stabilized by a Kalman filter with a predict–update mechanism. This approach ensures robust and reliable object tracking, providing valuable insights into tennis training performance, placement accuracy, and actionable insights for sports analytics. Full article

Background/Objectives: Restoring lower-limb strength and symmetry is crucial after ACL injury and reconstruction. The limb symmetry index (LSI) is often used to assess strength symmetry for return-to-sport decisions, but various assessment methods can influence outcomes. This study aimed to compare LSI across common knee flexor testing methods in healthy male athletes and to examine associations between absolute strength outcomes, thereby establishing baseline reference values for LSI in a healthy population. Methods: Twenty-two healthy recreationally active males participated in this prospective cross-sectional study. Knee flexor strength was assessed bilaterally using three force plate isometric tests, a static dynamometer-based test (isometric), and isokinetic dynamometer-based tests. Absolute strength values were normalized to body mass. LSI values were calculated for each testing condition. Differences in LSI across modalities were analyzed with repeated-measures ANOVA, and associations between normalized strength outcomes were assessed using Pearson correlation coefficients. Results: LSI values ranged from 96.69 to 101.83 across the testing conditions, with no significant differences observed between measures. Normalized absolute strength outcomes demonstrated very strong correlations within the same measurement category (r = 0.86–0.94 for force plate tests and r = 0.88–0.96 for isokinetic tests). In contrast, correlations between isometric and isokinetic strength outcomes were moderate (r = 0.41–0.67). Conclusions: LSI values were consistent across knee flexor strength testing modalities, suggesting that symmetry assessment was relatively consistent across different measurement methods in the studied group. In contrast, normalized absolute strength outcomes showed only moderate and variable associations across modalities, indicating that different testing approaches assess related but not interchangeable aspects of muscle strength. Full article

Background: Symptom scales are routinely used in sport during concussion screening and return-to-play. Limited research has explored the presence of concussion symptoms in the absence of a diagnosed concussion. This study analyzed concussion symptom scores in concussed vs. non-concussed football players after football activities and evaluated the effect of field of play variables. Methods: NCAA Division I football players with (n = 9) and without (n = 30) diagnosed concussion completed concussion symptom scales (C3 Logix) following practice for 1 week. Wet bulb globe temperature (WBGT), play duration, equipment, and location (inside/outside) were recorded. Mixed models analyzed the effect of day, WBGT, equipment, location, and play duration on concussion-like symptoms in non-concussed players and determined the time course of symptom relief in concussed players. Results: Fatigue or low energy (27.6%), neck pain (16.8%), feeling slowed down (14.8%), and headache (12.8%) were most reported. In non-concussed players, total symptoms scores were higher early in the week (Monday/Tuesday) and decreased throughout the week (p < 0.01). No effect of play duration (p = 0.49), WBGT (p = 0.12), equipment (p = 0.40), or location (p = 0.83) was found. Symptom scores were greater in the concussed vs. non-concussed groups on days 1–3. Conclusions: Football players report concussion-like symptoms in the absence of a concussion diagnosis, particularly following the first few practices after a game. Full article

(1) Background: Postoperative anterior cruciate ligament reconstruction often involves quadriceps strength asymmetry, leading to abnormal lower limb biomechanics during running. While previous studies have examined the relationship between isokinetic strength and walking or jumping, the association between running, a key criterion for return to sport, and lower limb biomechanics remains unclear, particularly regarding isokinetic strength asymmetry at different angular velocities. (2) Methods: Isokinetic quadriceps strength, running kinematic, and kinetic data were collected from 39 ACLR individuals. Paired t-tests compared bilateral differences, and Pearson correlation analysis assessed associations between biomechanical parameters and muscle strength. (3) Results: The injured leg showed significantly weaker Qc at 60°/s, 180°/s, and 300°/s (p < 0.05). Compared to the uninjured leg, the injured leg demonstrated a significantly greater hip flexion angle at initial contact (p < 0.05); the injured leg exhibited significantly reduced knee flexion angle at the time of peak vertical ground reaction force and peak knee flexion angle (p < 0.05); the injured leg exhibited significantly reduced knee flexion moment at PVGRF, peak knee flexion moment, peak knee extension moment (p < 0.05). Both the 60°/s Qc and Qe showed moderate negative correlations with knee flexion angles, and 180°/s Qc correlated with knee flexion moment at PVGRF (p < 0.05). (4) Conclusions: ACLR patients show quadriceps strength asymmetry and abnormal sagittal knee and hip biomechanics during running. Strength symmetry moderately correlates with knee kinematics and kinetics in a velocity-dependent manner. Rehabilitation should focus on multi-speed and eccentric training with neuromuscular and hip–knee coordination exercises to optimize movement and support safe return to sports. Full article

Background and Objectives: Present assessment methods have not effectively mitigated the risk of recurrent anterior cruciate ligament (ACL) injury following reconstruction (ACLR), suggesting that critical neuromuscular deficits may be underdiagnosed. This study aimed to compare limb asymmetries across strength, concentric and eccentric power, and deceleration metrics during return-to-sport (RTS) testing in professional athletes post-ACLR. Materials and Methods: Forty-four participants (33 males, 11 females; age 22.5 ± 5.8 years, body mass 75.9 ± 13.0 kg, height 180.5 ± 8.38 cm) (mean ± SD) with a unilateral reconstructed ACL (BTB = 33, HT = 11 graft) were included. They underwent isokinetic testing of knee flexor and extensor strength and bilateral countermovement jump (CMJ) assessments to measure concentric and eccentric peak power and deceleration metrics. Limb symmetry indices (LSI) were calculated for each parameter. Welch’s ANOVA and Games–Howell post hoc tests were used to compare LSIs among parameters. Results: Welch’s ANOVA showed that limb symmetry differed significantly across the measured neuromuscular parameters (F = 12,59, p < 0.001). Knee flexor strength LSI was significantly higher than knee extensor strength LSI (p = 0.003; d = 1.18), concentric peak power LSI (p < 0.001, d = 1.44), eccentric peak power LSI (p = 0.001, d = 1.71), and deceleration LSI (p = 0.001, d = 2.09). In addition, deceleration LSI was significantly lower than knee extensor strength LSI (p = 0.001, d = 1.34) and concentric peak power LSI (p = 0.007, d = 1.10). No significant difference was found between concentric and eccentric peak power, nor between knee extensor strength and either concentric or eccentric peak power LSIs. Conclusions: The findings of this study revealed significantly greater asymmetries in load absorption capacity compared to strength and concentric power measures at return-to-sport time frame in professional athletes post-ACLR. Full article

Background/Objectives: Anterior cruciate ligament reconstruction (ACLR) is a common orthopedic procedure; however, successful return to sport (RTS) remains a major challenge influenced by both physical and psychological factors. Kinesiophobia and psychological readiness are crucial yet inadequately studied components of rehabilitation that may change across distinct phases. This study aimed to examine longitudinal, phase-specific changes in kinesiophobia, psychological readiness, and patient-reported knee function across standardized ACLR rehabilitation phases. Methods: A retrospective longitudinal cohort design was employed. Data were extracted from 45 patients who completed ACLR rehabilitation at a specialized musculoskeletal center in Riyadh, Saudi Arabia. Participants were assessed across four rehabilitation phases: Phase One (0–1 month), Phase Two (>1–3 months), Phase Three (>3–6 months), and Phase Four (>6 months post-ACLR). Outcomes included the Tampa Scale of Kinesiophobia (TSK-17), the ACL–Return to Sport after Injury scale (ACL-RSI), and the International Knee Documentation Committee subjective knee form (IKDC), administered using validated Arabic versions. Linear mixed-effects models with Bonferroni-adjusted pairwise comparisons were used to evaluate phase-related changes. Results: Significant fixed effects of rehabilitation phase were observed for all outcomes (p < 0.001). Kinesiophobia declined substantially from Phase One (mean 51.5) to Phase Three (34.7), with the greatest reduction between Phases Two and Three, followed by stabilization in Phase Four. Psychological readiness increased progressively across all phases (ACL-RSI: 37.1 to 61.8). Knee function demonstrated the greatest improvement during late rehabilitation (IKDC: 37.6 to 75.8). Conclusions: Psychological and functional recovery following ACLR follow distinct temporal trajectories rather than improving synchronously. Kinesiophobia declines most markedly during mid-rehabilitation, while functional gains peak in late rehabilitation. These findings support integrating structured psychological screening into phase-specific ACLR rehabilitation protocols. Full article