搜索结果：Clinics in sports medicine

Female athletes have unique risk factors for injury in both contact and noncontact sports. There are anatomic, neuromuscular, and biologic differences between the sexes that cause female athletes to experience certain injuries during sports at higher frequencies than their male counterparts. Understanding injury patterns specific to female athletes is crucial for developing prevention strategies, improving training protocols, and ensuring better recovery outcomes. This research can assist medical professionals, coaches, and training staff with creating tailored approaches to injury prevention and management.

Patient-specific instrumentation (PSI) may help improve outcomes following high tibial osteotomy (HTO). Three-dimensional preoperative planning allows for multiplanar osteotomy templating that can precisely restore the mechanical axis while limiting unintended sagittal plane abnormalities, facilitating execution of complex biplanar corrections. Patient-specific cutting guides and anatomically contoured implants reduce risk for intraoperative complications and streamlines operative efficiency. Though lacking long-term data to establish clinical superiority of PSI over traditional HTO techniques, early reports demonstrate PSI is highly accurate, safe, and effective. Understanding the advantages and limitations of PSI is crucial in making informed decisions when implementing this new technology in osteotomy surgery.

Injury prevention is an important aspect of female sports and requires a multi-disciplinary approach. This article provides a general overview of extrinsic and intrinsic risk factors for injury, focusing on female sex-specific risk factors that should be acknowledged in young athletes. We also discuss the importance of pre-participation physical examinations, injury prevention programs, and promoting well-balanced diets and training schedules in athletes to maximize performance while minimizing injury risk.

Persisting symptoms after concussion (PSaC) is a common issue affecting individuals diagnosed with concussion, posing a formidable challenge for both clinicians and patients. Recognizing the distinct pathology of PSaC and differentiating it from the transient physiologic effects of concussion is paramount. Optimal management strategies seamlessly integrate lifestyle modifications, pharmacologic interventions, manual therapies, procedural techniques, and graded activity reintroduction. This multidisciplinary, tailored approach promises to facilitate recovery while minimizing the enduring burden of symptoms, offering renewed hope for those affected.

Muscle injuries are a frequent concern in competitive athletes and military personnel, often hindering their ability to continue in their sport or service. Due to the significant impact of these injuries and the urgency of returning to activity, orthobiologics such as prolotherapy, platelet-rich plasma, and mesenchymal stem cells have been explored as treatment options aimed at promoting tissue regeneration through immunomodulation toward tissue regeneration. However, despite growing interest and numerous preclinical studies, high-level clinical evidence supporting the efficacy of these treatments remains lacking, underscoring the need for further research.

Female athletes are susceptible to traumatic anterior shoulder instability, possibly due to higher levels of ligamentous laxity leading to soft tissue capaciousness. Rates of shoulder instability are near equal between male and female athletes. Rehabilitation is the initial treatment to improve scapular stabilization and rotator cuff strengthening. If conservative treatment fails, surgical treatment includes arthroscopic versus open Bankart repair for anterior shoulder instability. Surgical intervention for multidirectional instability may include open inferior capsular shift or arthroscopic capsular plication. Postoperative rehabilitation focuses on regaining the full range of motion and strength to pre-injury values before returning to performance.

Osteotomies around the knee are an effective procedure that shifts the weight-bearing axis from the pathologic side to the uninvolved side to alleviate pain, unload cartilage transplantations, slow down the progression of arthritis, and protect ligament reconstructions. The advancement in plates from nonlocking to locking have increased the stability of constructs to allow for early mobilization and maintained corrections. Further developments with patient-specific instrumentation have made these techniques more reproducible and accurate. Bone grafting and biologics remain a topic of debate but likely a helpful adjuvant in the context of larger corrections or joint preservation surgeries.

Patellofemoral pain and instability are debilitating conditions, most commonly presenting in a young, predominantly female patient cohort. Assessment of underlying pathophysiology requires a detailed history, focused physical examination, and proper assessment of advanced imaging. Treatment, both operative and nonoperative, is focused on reducing the risk of recurrent instability and chondral damage, to provide a patient with a pain-free, stable knee. It is essential to have a comprehensive understanding of the patient's demographic and anatomic risk profile to best determine the most appropriate and effective treatment course and mitigate their risk of recurrence.

Artistic gymnastics is a demanding sport that puts unique stressors on the female athlete's body, predisposing them to certain acute and chronic conditions. Intense and repetitive upper extremity weight-bearing, particularly in skeletally immature gymnasts, can contribute to capitellar osteochondritis dissecans and distal radial physeal injuries. Repetitive lumbar hyperextension and rotation can contribute to spondylolysis. Physicians treating adolescent idiopathic scoliosis in gymnasts may consider additional counseling or modified treatment to maximize outcomes while aligning with athletic goals. Physicians treating elite-level gymnasts should be aware of training demands and the history of pervasive mistreatment within the sport.

Concussion, a form of mild traumatic brain injury, can occur due to direct or indirect forces resulting in transient neurological dysfunction. Several biomechanical forces may play a role in the number and severity of concussion symptoms. Protective gear such as helmets, mouthguards, and headgear may offer varying levels of efficacy regarding prevention depending on the sport and setting. Advancing our understanding of concussion biomechanics for specific sports settings may aid in individualizing care strategies aimed at increasing diagnostic capabilities, prevention through protective equipment development, and long-term outcomes in high-risk groups.

Relative energy deficiency in sport, previously known as the female athlete triad, is under-recognized by coaches, physicians, and the medical team. It is a multifactorial clinical syndrome driven by problematic low energy availability (LEA) in the athlete. LEA is the underlying etiology that results in body system dysfunction including physical and psycholgical function as well as an increase in injuries and decline in performance. There are risk assessment tools that can be used to triage and manage the female athlete, and treatment often requires a multidisciplinary approach.

Stress fractures are fatigue fractures of bone that result from an overuse mechanism. These injuries present most commonly in the legs and feet of distance runners and military personnel but can also occur in the upper extremity and the spine depending on the causative activity. Nutritional, hormonal, and biomechanical factors influence the development of bone stress injuries, and no two bone stress injuries behave identically. A thorough history, detailed physical examination, and proper imaging are required to diagnose and classify these injuries. Management of stress injuries requires nutritional and emotional support, rest from the causative activity, and occasionally surgical intervention.

Anterior cruciate ligament (ACL) deficiency leads to knee instability and increased joint degeneration. While ACL reconstruction (ACLR) is common, a steep posterior tibial slope (PTS) raises the risk of graft failure. Anterior closing wedge osteotomy (ACWO), or tibial deflexion osteotomy, is an effective surgical option for high PTS, especially in revision cases. ACWO alters tibial slope, reducing strain on ACL grafts and improving stability. With excellent long-term outcomes, including low rerupture rates and good return-to-sport results, ACWO is effective in cases with increased tibial slope and static anterior tibial translation, though its role in primary ACLR is still debated.

Ligament injuries are a common type of musculoskeletal condition, with an estimated 17 million occurring annually in the United States, resulting in an economic burden exceeding US$40 billion. The growing demand for faster recovery and better surgical outcomes has led to increased interest in orthobiologics. However, the wide variability in ligament healing, surgical techniques, biological factors, and preparation methods makes it challenging to generalize research results. More studies are needed to fully understand the impact of current orthobiologics on ligament healing. Although current research in ligament repair and reconstruction enhanced with orthobiologics shows promise, it is still not fully evidence-based.

Concussion is a complex brain injury affecting neurons and nonneuronal cells such as astrocytes, oligodendrocytes, microglia, and endothelial cells, leading to acute neurometabolic disturbances such as ionic imbalance and energy crisis. Beyond metabolism, these cellular responses may drive inflammation, blood-brain barrier disruption, neuroplasticity, glymphatic dysfunction, and neurodegeneration. Recognizing biological vulnerability and knowledge regarding repeat concussions has shaped protocols to prevent premature return to activity and reduce further injury risk. The concept of concussion and postconcussion endotypes, linking persistent symptoms to specific biological mechanisms, guides targeted diagnosis and treatment. Ongoing research into biomarkers and mechanisms aims to improve prognostication and develop personalized treatments for recovery.

暂无摘要（点击查看详情）

Subchondral bone pathology (SBP) includes a wide range of pathologies, including trauma, postcartilage surgery, osteoarthritis, transient bone marrow syndromes, spontaneous insufficiency fractures, and osteonecrosis. They show joint MRI findings termed bone marrow lesions. However, the etiology and evolution of SBP in multiple conditions remain unclear. A key factor to address in a patient with BME is the distinction between reversible and irreversible lesions. MRI plays a significant role in the differential diagnosis based on recognizable typical patterns considered together with coexistent abnormalities, age, and clinical history. This article will focus on the current understanding of the biologics of SBP.

Ankle sprains are a very common injury in the athletic population, with up to 30% of acute ankle sprains progressing to chronic ankle instability. Female athletes are at greater risk of developing chronic lateral ankle instability, likely secondary to hormonal fluctuations. Despite this, further work is needed to investigate the relationship between gender and chronic lateral ankle instability. When conservative management fails, surgical reconstruction of the lateral ligaments, typically in the form of an open modified Brostrom-Gould procedure, is required to restore stability. Recent evidence suggests arthroscopic Brostrom-Gould procedure may be the new gold standard.

Post-traumatic headache (PTH) is a common sequela following mild traumatic brain injury. In recent years, there has been a growing recognition toward the cervical spine and its structures as an identified contributor toward one's symptoms. In this article, we discuss various etiologies including the cervical facet joints, musculoligamentous structures, occipital nerves, and cervical discs, and how they may contribute to PTH. For each of these conditions, common clinical presentation, diagnosis, and therapeutic approaches are discussed.