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Problem Statement: In athletes with spondylolisthesis, segmental instability and impaired spinopelvic alignment are considered as clinically relevant. Functional MRI in supine and upright position enables a load-dependent acquisition, but neither the reposition effect nor the difference in the extent of inter-position-related differences has been investigated for their reliability. This study evaluates the intra- and inter-positional test-retest reliability of segmental instability and spinopelvic alignment in athletes with low-grade isthmic lumbar spondylolisthesis using supine and upright MRI.Methods: 22 athletes with spondylolisthesis were analyzed in a test-retest design. Parameters quantifying segmental instability (anterior translation [mm], segmental hinging [], disc height [mm]) and spinopelvic alignment (lordosis angle [], Sacral slope []),) were assessed in supine (0) and upright (82) MRI position. Intra-positional changes and differences of inter-positional changes were analyzed using absolute and relative indicators of reliability (amongst other intraclass-correlation-coefficient (ICC 2.1) and standard error of measurements (SEM%)).Results: Intra-positional changes showed high correlations and low absolute changes in both positions (ICC: 0.91-0.98; SEM%: 1-7%). Differences of inter-positional changes presented poor-to-moderate correlations and higher absolute changes (ICC: 0.34-0.74; SEM%: 33-60%).Discussion: Intra-positional changes can be determined reliably among all assessed outcomes. Inter-position-related changes of segmental instability indicate a reduced reproducibility in the current population.Conclusion: Functional MRI can be considered a valuable diagnostic tool for evaluating segmental instability and spinopelvic alignment in spondylolisthesis patients. Key Words: Reproducibility, MRI, Spinopelvic Balance, Repositioning, Functional Imaging

Bone stress injuries, commonly referred to as stress reactions or stress fractures, are caused by overuse and are prevalent conditions in athletes. These injuries are often seen in sports with high cumulative skeletal loading such as running, athletics, gymnastics, basketball, cricket, or soccer. The main injury pathophysiology is an imbalance between bone microdamage formation and its removal and replacement. A detailed medical history and clinical examination are important for diagnosis, with magnetic resonance imaging representing the gold standard for radiographic confirmation. Treatment and return-to-sport decisions should be individualized and based on injury location, severity, aspects of sports participation, and patient preferences. Initial management includes activity modification, protected weight-bearing, immobilization, optimizing nutrition (caloric intake, dietary calcium, and vitamin D supplementation), and in a few cases surgery. Following initial treatment, progressive loading and return-to-activity are initiated. Overall, a high rate of return-to-sports can be expected. Numerous risk factors that alter bone loading or bone health have been described and their identification is a crucial step towards prevention of future injury.Key Words: Stress Reaction, Stress Fracture, Bone Overuse

Joint replacement surgery has showna tremendous increase within the last decades. Advanced operation techniques and modern implants support operative treatment of younger patients with increased demands during daily-living, leisure time as well as sports activity. Physical activity after total joint replacement is generally recommended. This leads to improved osteointegration of the prosthesis, decreased loosening rates, enhanced muscular performance and a reduced cardiovascular risk. Potential recommendations regarding suitable activitiesand intensities depend on the affected joints, surgical techniques, implantsusedas well as accompanying pathologies. While low-impact-sport with mainly cyclic endurance activity is generally recommended, high-impact-sport can only be permitted with previous experience and atcertain arthroplasty sites. Due to high risk of injuries participation in contact and game sports should generally be avoided.KEY WORDS: Sport Recommendation, Physical Activity, Joint Replacement, Prosthesis, Patients