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Background: The Nine Plus screening battery test (9+) is a functional movement test intended to identify limitations in fundamental movement patterns predisposing athletes to injury. However, the interseason variability is unknown.Aim: To examine the variability of the 9+ test between 2 consecutive seasons in professional male football players.Methods: Asymptomatic Qatar Star League players (n=220) completed the 9+ at the beginning of the 2013 and 2014 seasons. Time-loss injuries in training and matches were obtained from the Aspetar Injury and Illness Surveillance Program. No intervention was initiated between test occasions.Results: A significant increase in the mean total score of 1.6 points (95% CI 1.0 to 2.2, p<0.001) was found from season 1 (22.2±4.1 (SD)) to season 2 (23.8±3.3). The variability was large, as shown by an intraclass correlation coefficient (ICC) of 0.24 (95% CI 0.11 to 0.36) and a minimal detectable change (MDC) of 8.7 points. Of the 220 players, 136 (61.8%) suffered a time-loss injury between the 2 tests. There was an improvement in mean total scores in the injured (+2.0±0.4 (SE), p<0.001) group but not in the uninjured group (+0.9±0.5, p=0.089). The variability from season 1 to season 2 was large both in the injured (ICC 0.25, 0.09 to 0.40, MDC 8.3) and uninjured (ICC 0.24, 0.02 to 0.43, MDC 9.1) groups.Conclusions: The 9+ demonstrated substantial intraindividual variability in the total score between 2 consecutive seasons, irrespective of injury. A change above 8 points is necessary to represent a real change in the 9+ test between seasons. [ABSTRACT FROM AUTHOR]

Objective: Most studies examining the time to return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR) do not account for the athlete's physical readiness. This study aimed to investigate the status of male athletes at 2 years after ACLR, the factors affecting a return to pivoting sports, and the association between time to RTS and subsequent knee injury risk for those athletes who met discharge criteria., Methods: We prospectively followed 530 male athletes (mean age 26.7±7.7 years) participating in pivoting sports throughout rehabilitation and at 2 years after ACLR. Pair-wise analyses were conducted to compare athletes who returned to pivoting sports and those who did not. We performed a Cox regression analysis to assess the association between subsequent non-contact or indirect contact knee injuries and time to RTS. Pearson's χ 2 test was used to compare athletes who RTS in ≤9 months to those who RTS in >9 months after ACLR., Results: In total, 379 (72%) athletes returned to pivoting sports at 2 years after ACLR. Athletes who completed rehabilitation and met discharge criteria (n=190) were almost 6 times more likely to return to their preinjury sport (OR 5.71; 95% CI 3.39 to 9.62). Of those who did not complete their rehabilitation (n=340), 132 (39%) did not return to pivoting sports. For athletes who met discharge criteria, time to RTS was not associated with the risk of new knee or ACL injury. There was no increased risk for new knee (HR 0.892, 95% CI 0.39 to 2.07, p=0.79) or ACL (HR 0.718, 95% CI 0.24 to 2.17, p=0.56) injury whether athletes returned before or after the 9-month mark following ACLR., Conclusions: Completing rehabilitation and meeting objective criteria significantly increased the odds for male athletes to return to pivoting sports. Time to RTS did not impact the risk for a new knee or ACL injury if athletes met objective criteria., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background/purpose: The assessment of ankle plantarflexion force is commonly required in athletic performance and clinical rehabilitation settings to assess the integrity of the calf and lower limb musculature. The force generating capacity of the soleus muscle is thought to be important in many aspects of sporting and everyday function. Unfortunately, there are only a few reliable tests describing the assessment of the strength of the soleus muscle, especially in dorsiflexion greater than plantar grade/neutral which mimics ankle joint positions associated with higher ground contact forces. Accordingly, the purpose of this study is to describe the reliability, feasibility, and clinimetrics of a novel test of plantarflexion force in a clinical setting., Methods: Test-retest reliability of a seated isometric plantar flexion strength test performed a minimum of one day apart (maximum of six) using the maximum value of four trials was investigated using a force plate and custom apparatus in 61 volunteer adults (of varying activity levels (Tegner one to ten). Inter-rater reliability (ICC 2,1 ), Bland-Altman, and minimal detectable change values were estimated., Results: Sixty-one subjects were tested (49 male, 12 female, 39.6±12.6 years, 81.1±13.8kg). Excellent test-retest reliability was demonstrated (ICC 2,1 )=0.976 [0.97 to 0.98], p<0.001; and minimal detectable change (MDC) was found to be 118N., Conclusion: Excellent test-retest reliability and a minimal detectable change of 118N (14.8% bodyweight) were demonstrated for this measure of plantar flexion force. MDC data can inform clinical progression and between-limb differences in healthy and injured individuals. Further, these results can be used to explore the clinical importance of the measurement using the instrumentation., Level of Evidence: 3b., Competing Interests: The authors note that while they developed the custom strength testing device, they have no financial links, nor any conflicts of interest perceived or actual regarding this device. Specifically, the device is not for sale by the authors or any of their affiliates, and we have provided all information for readers to manufacture their own versions of the same herein or upon reasonable request., (© The Author(s).)

Purpose: To compare patient-reported outcomes between acute ligamentous ankle injuries 1) without anterior syndesmosis involvement and 2) with anterior syndesmosis involvement (without clinical instability)., Study Design: Prospective cohort study., Methods: Between September 2016 and December 2020 all athletes (≥18) with an acute ankle injury presenting within 7 days post-injury were screened for eligibility. Athletes were excluded if imaging demonstrated a frank fracture or 3T magnetic resonance imaging could not be acquired within 10 days post-injury. Athletes with unstable syndesmosis injuries or athletes who underwent surgery within 1-year post-injury were excluded. Athletes underwent criteria-based rehabilitation and functional outcomes (Karlsson & Peterson score, Foot and Ankle Outcome Score) were assessed at 6 weeks, 6 months, and 1 year., Results: A total of 94 athletes were included. In 28 athletes (30 %) the anterior syndesmosis was injured. In the first six weeks post-injury, median Karlsson & Peterson score improved from 37 (interquartile range 20.5-49) to 80 (interquartile range 70-90) for the group without involvement versus 35 (interquartile range 25-62) to 82 (interquartile range 72-87) for the group with involvement. FAOS sports improved similarly in both groups. No statistically significant between group differences in functional outcome scores were observed at six weeks, six months and 1 year follow-up., Conclusions: In athletes, acute ligamentous ankle injuries with involvement of the anterior syndesmosis ligament (without clinical instability) are not associated with worse functional outcome at 6 weeks, 6 months, and 1-year post-injury compared to acute ligamentous ankle injuries without involvement., Competing Interests: Declaration of interest statement No conflict of interest, financial or other, exists., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To describe and categorise the injury-inciting circumstances of sudden-onset hamstring match injuries in professional football players using systematic video analysis., Methods: Using a prospective injury surveillance database, all sudden-onset hamstring match injuries in male football players (18 years and older) from the Qatar Stars League between September 2013 and August 2020 were reviewed and cross-referenced with broadcasted match footage. Videos with a clear observable painful event (ie, a player grabbing their posterior thigh) were included. Nine investigators independently analysed all videos to describe and categorise injury-inciting circumstances. We used three main categories: playing situation (eg, time of injury), player action(s) (eg, running) and other considerations (eg, contact). Player action(s) and other considerations were not mutually exclusive., Results: We included 63 sudden-onset hamstring match injuries out of 295 registered injuries between 2013 and 2020. Running was involved in 86% of injuries. Hamstring injuries occurred primarily during acceleration of 0-10 m (24% of all injuries) and in general at different running distances (0-50 m) and speeds (slow to fast). At 0-10 m distance, indirect player-to-player contact and inadequate balance were involved in 53% and 67% of the cases, respectively. Pressing occurred in 46% of all injuries (injured player pressing opponent: 25%; being pressed by opponent: 21%) and frequently involved player-to-player contact (69% of the cases when the injured player was pressing vs 15% of the cases when the opponent was pressing) and inadequate balance (82% vs 50%, respectively). Other player actions that did not involve running (n=9, 14% of all injuries) were kicking (n=6) and jumping (n=3)., Conclusion: The injury-inciting circumstances of sudden-onset hamstring match injuries in football varied. The most common single-player action (24%) was acceleration over a distance of <10 m. Pressing, inadequate balance and indirect contact were frequently seen player actions. Injury prevention research in football should look beyond high-speed running as the leading risk factor for sudden-onset hamstring injuries., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Knee extension range of motion (ROM) measurement is important in patients with anterior cruciate ligament (ACL) injury. The main objective is to evaluate the reliability and the minimal detectable change (MDC) of three methods of measuring knee extension ROM in ACL patients. The three common goniometric devices were a universal goniometer, an inclinometer, and a smartphone app. During a single-visit, knee extension ROM was measured in both knees of 92 ACL-injured or -reconstructed patients by two testers blinded to the other's measures. Intrarater, interrater, and test-retest intraclass correlation coefficients (ICC 2,1 ) were calculated. Intrarater ICC 2,1 was excellent for the three devices ranging from 0.92 to 0.94, with the inclinometer yielding the best results (ICC 2,1  = 0.94 [95% confidence interval, CI: 0.91-0.96]). Interrater ICC 2,1 , however, varied from 0.36 to 0.80. The inclinometer and the smartphone app yielded similar results 0.80 (95% CI: 0.71-0.86) and 0.79 (95% CI: 0.70-0.86), respectively, whereas the universal goniometer was 0.36 (95% CI: 0.17-0.53). Test-retest ICC 2,1 for the inclinometer was 0.89 (95% CI: 0.84-0.93), 0.86 (95% CI: 0.79-0.91) for the app, and 0.83 (95% CI:0.74-0.89) for the goniometer. The intrarater, interrater, and test-retest MDC 95 values ranged from 2.0 to 3.5, 3.7 to 10.4, and 2.6 to 5.4 degrees, respectively. The goniometer was the least reliable. The inclinometer is the recommended device due to its highest ICC scores among the three devices and ease of use., Competing Interests: None declared., (Thieme. All rights reserved.)

OBJECTIVE: To determine the Fragility Index of hamstring injury risk factors, defined as the minimum number of participants who would need to change classification to make a hamstring injury risk factor statistically nonsignificant. DESIGN: Retrospective secondary data analysis. METHODS: Studies that investigated 1 or more risk factors for hamstring injury, and presented sufficient data to develop a 2 × 2 contingency table were included. A systematic literature search and reference screening of a recent hamstring injury systematic review were conducted to identify 78 articles. Relative risk and 95% confidence intervals were determined and then systematically recalculated by removing 1 observation from the high-risk injury count and adding it to the high-risk noninjury count. The Fragility Index for a risk factor was the number of observations required to be moved between groups until the relative risk was no longer significant. RESULTS: The median Fragility Index of all hamstring injury risk factors was 3 (Q1-Q3 = 2-6). The Fragility Index for nonmodifiable risk factors was 3 (Q1-Q3 = 2-6) and 3 (Q1-Q3 = 2-5) for modifiable risk factors. Over 35% of all included hamstring injury risk factors had a Fragility Index of ≤2. CONCLUSION: Most statistically significant hamstring injury risk factors are fragile associations. The interpretation of significant hamstring injury risk factors should consider a range of statistical metrics, and while the Fragility Index should never be considered in isolation, it is an intuitive measure to help assess the robustness of findings. J Orthop Sports Phys Ther 2024;54(10):672-678. Epub 4 September 2024. doi:10.2519/jospt.2024.12300 .

Objectives: Neuronal ceroid lipofuscinosis type 2 (CLN2-disease) is an inherited childhood-onset neurodegenerative condition, with classical early features of speech delay, epilepsy, myoclonus, ataxia, and motor regression. This study aimed to better characterize the spectrum of movement disorders in CLN2-disease in a cohort of children receiving enzyme replacement therapy (ERT)., Methods: A cohort of 18 children attending a single center for treatment with cerliponase alfa ERT was systematically assessed using a standardized structured history and a double-scored, video-recorded examination using the Unified Batten Disease Rating Scale (UBDRS) and Abnormal Involuntary Movement Scale., Results: Noncanonical movement disorders are common: while ataxia (89%) and myoclonus (83%) were near-universal, spasticity and dystonia were experienced by over half (61% each), with children having a median of 4 distinct movement disorder phenotypes. This progression was stereotyped with initial ataxia/myoclonus, then hyperkinesia/spasticity, and later hypokinesia. ERT slows progression of movement disorders, as measured by the UBDRS physical subscale, with 1.45 points-per-month progression before diagnosis and 0.44 points-per-month while on treatment ( p = 0.019)., Discussion: Movement disorders are a core feature of CLN2-disease and follow a typical pattern of progression which is slowed by ERT. Identifying and treating movement disorders should become standard, especially given increased patient survival.

Objectives: Studies identifying clinical and MRI reinjury risk factors are limited by relatively small sample sizes. This study aimed to examine the association between baseline clinical and MRI findings with the incidence of hamstring reinjuries using a large multicentre dataset., Methods: We merged data from four prospective studies (three randomised controlled trials and one ongoing prospective case series) from Qatar and the Netherlands. Inclusion criteria included patients with MRI-confirmed acute hamstring injuries (<7 days). We performed multivariable modified Poisson regression analysis to assess the association of baseline clinical and MRI data with hamstring reinjury incidence within 2 months and 12 months of follow-up., Results: 330 and 308 patients were included in 2 months (31 (9%) reinjuries) and 12 months (52 (17%) reinjuries) analyses, respectively. In the 2-month analysis, the presence of discomfort during the active knee extension test was associated with reinjury risk (adjusted risk ratio (ARR) 3.38; 95% CI 1.19 to 9.64). In the 12 months analysis, the time to return to play (RTP) (ARR 0.99; 95% CI 0.97 to 1.00), straight leg raise angle on the injured leg (ARR 0.98; 95% CI 0.96 to 1.00), the presence of discomfort during active knee extension test (ARR 2.52; 95% CI 1.10 to 5.78), the extent of oedema anteroposterior on MRI (ARR 0.74; 95% CI 0.57 to 0.96) and myotendinous junction (MTJ) involvement on MRI (ARR 3.10; 95% CI 1.39 to 6.93) were independently associated with hamstring reinjury., Conclusions: Two clinical findings (the presence of discomfort during active knee extension test, lower straight leg raise angle on the injured leg), two MRI findings (less anteroposterior oedema, MTJ involvement) and shorter time to RTP were independently associated with increased hamstring reinjury risk. These findings may assist the clinician to identify patients at increased reinjury risk following acute hamstring injury., Trial Registration Numbers: NCT01812564; NCT02104258; NL2643; NL55671.018.16., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Athletes who are well prepared for the physical demands of competition are less susceptible to injury. Defining and then preparing athletes for these in-game demands is critical to athlete health and performance. The injury burden within Major League Baseball (MLB) is significant and differs by position. Despite its importance, the workload demands have not been described for position players in MLB., Hypothesis: That running demands would be significantly higher for outfielders, followed by infielders, and catchers, respectively, while batting and baserunning metrics would be similar across positions., Study Design: Cohort study., Level of Evidence: Level 3., Methods: Total and high-speed running distance (>75% Vmax), high-speed running count, hard accelerations (>2.78 m/s/s), defensive and baserunning minutes, total and hard throws (>75% max), and bat swing counts were calculated from Statcast data. Players with 100 games or more in the 2018 season ( n = 126) were included for analysis., Results: All offensive and baserunning metrics were similar across positions; however, significant positional differences were observed for defensive and overall workload metrics. High-speed running was highest among outfielders ( F 1,7 = 27.1, P < 0.01), followed by infielders, then catchers. Hard accelerations ( F 1,7 = 12.9, P < 0.01) were highest among first basemen, then outfielders, remaining infielders, and catchers. Total throws ( F 1,7 = 17.7, P < 0.01) were highest among middle infielders. Hard throws ( P < 0.01) were highest among shortstops and third basemen., Conclusion: In-game workloads differ significantly by defensive position in MLB. These differences in running, throwing, and hitting volumes have significant implications for physical preparation and injury return-to-play progressions to optimize performance and minimize injury and reinjury risk for these athletes., Clinical Relevance: These data provide insight into how best to prepare athletes of different positions for the demands of the game both in terms of preseason preparation as well as return-to-play benchmarks following injury. These data should also serve as a platform for future research into the relationship between workload and injury among professional baseball players., Competing Interests: The authors report no potential conflicts of interest in the development and publication of this article.

The aim was to determine how jump load affects knee complaints in elite men's volleyball. We collected data from four men's premier league volleyball teams through three seasons in a prospective cohort study (65 players, 102 player-seasons). Vert inertial measurement devices captured the jump load (jump frequency and jump height) from 21 088 daily player sessions, and knee complaints were reported in 3568 weekly OSTRC-O questionnaires. Mixed complementary log-log regression models described the probability of (i) experiencing symptoms if players were currently asymptomatic, (ii) worsening symptoms if players had symptoms, and (iii) recovery from knee complaints. Based on our causal assumptions, weekly jump load was modeled as the independent variable, adjusted for age (years), weight (kg), position on volleyball team, and past jump load. No certain evidence of an association was found between weekly jump load and probability of (i) knee complaints (p from 0.10 to 0.32 for three restricted cubic splines of load), (ii) worsening symptoms if the player already had symptoms (p from 0.11 to 0.97), (iii) recovery (p from 0.36 to 0.63). The probability of knee complaints was highest for above-average weekly jump load (~1.2% for an outside hitter with mean age and height) compared with low loads (~1%) and very high loads (→ ~ 0%). The association between jump load and knee complaints risk remains unclear. Small differences in risk across observed jump load levels were observed. It would likely require substantially increased sample sizes to detect this association with certainty., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Anterior cruciate ligament (ACL) injuries are commonly assessed using clinical examination and magnetic resonance imaging, but these methods have limitations in reproducibility and quantification. Instrumented laxity measurements using devices, like the DYNEELAX®, offer an alternative approach. However, to date, there is no human data on the DYNEELAX® and the reliability of these devices remains a subject of debate, and there is no consensus on appropriate knee tightening levels for testing. We hypothesized that the DYNEELAX®, with standardized knee tightening, would provide reliable measurements of knee laxity in adult volunteers., Methods: This prospective cohort study involved 48 pain-free adult volunteers. Laxity measurements were taken using a robotic-type motorized instrument (DYNEELAX®) on two separate occasions, at least 1 h and no more than 8 h apart, with knee tightening forces of 90 N ± 5 N. Metrics of anterior tibial translation and internal/external tibial axial rotations were recorded., Results: The device displayed excellent intrarater reliability for all the metrics, with intraclass correlation coefficients ranging from 0.91 to 0.96. Anterior translation exhibited the highest reliability (intraclass correlation coefficient = 0.96), with a minimum detectable change of 0.83 mm., Conclusions: DYNEELAX® is reliable in measuring knee laxity in adult volunteers when using standardized stabilizing knee tightening forces of 90 ± 5 N. The most sensitive measurement parameters (in terms of minimum detectable change as a proportion of the observed range) were anterior translation (in mm) at 150 N and secondary compliance., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this article., (Copyright © 2024 Nuno Nascimento et al.)

Background/objectives: CLN2 Batten Disease is a fatal neurodegenerative condition of childhood associated with retinal dystrophy and blindness. Intracerebroventricular infusion of rhTPP1 greatly slows the rate of neurodegenerative decline but not retinopathy. Intravitreal rhTPP1 is known to slow retinal degeneration in a canine model of CLN2. We report a first-in-man controlled clinical trial of intravitreal rhTPP1 for CLN2 associated retinal dystrophy., Subjects/methods: 8 children aged 5-9 with CLN2 Batten Disease were prospectively enroled. Severely affected patients were preferentially selected, provided that vision was better than no perception of light. Children underwent 8 weekly intravitreal injections of rhTPP1 (0.2 mg in 0.05 ml) into the right eye for 12-18 months. The left eye was untreated and acts as a paired control. The primary outcome was safety based on the clinical detection of complications. A secondary outcome was paracentral macular volume (PMV) measured by spectral domain OCT. Linear regression/paired t tests were used to compare rates of decline., Results: No severe adverse reactions (uveitis, raised IOP, media opacity) occurred. The mean baseline PMV was 1.28 mm 3 (right), 1.27 mm 3 (left). 3 of the youngest patients exhibited bilateral progressive retinal thinning (p < 0.05), whereas retinal volume was stable in the remaining 5 patients. In the 3 patients undergoing retinal degeneration, the rate of PMV loss was slower in the treated vs. untreated eye (p = 0.000042, p = 0.0011, p = 0.00022)., Conclusions: Intravitreal rhTPP1 appears to be a safe and effective treatment for CLN2 related retinopathy however commencement of treatment early in the course of disease is more likely to be efficacious., (© 2023. The Author(s).)

OBJECTIVE: To describe the changes in quadriceps and hamstrings muscle strength in the uninvolved limb of male professional and recreational athletes during rehabilitation after anterior cruciate ligament reconstruction (ACLR) and compare to preoperative strength values. DESIGN: Prospective longitudinal study. METHODS: During rehabilitation, 665 participants who underwent unilateral ACLR performed a strength test preoperatively and every 6 weeks after surgery for up to 9 months. Isokinetic quadriceps and hamstrings strength of the uninvolved limb were measured at an angular velocity of 60°/s and normalized to body weight (N·m/kg). RESULTS: Quadriceps and hamstrings strength of the uninvolved limb gradually increased during rehabilitation until 6 months post-ACLR, and plateaued thereafter. Postoperative quadriceps' strength significantly exceeded preoperative values by 3 months for professional (2.99 N·m/kg; 95% confidence interval [CI]: 2.93, 3.04; P = .007) and by 6 months for recreational athletes (2.77 N·m/kg; 95% CI: 2.71, 2.83; P <.001), and hamstrings exceeded presurgery levels by 4.5 months (1.71 N·m/kg; 95% CI: 1.67, 1.74; P <.001 and 1.43 N·m/kg; 95% CI: 1.40, 1.46; P = .002, professional and recreational athletes respectively). CONCLUSION: In male professional and recreational athletes, uninvolved limb quadriceps and hamstrings strength gradually improved after ACLR, until 6 months after surgery. The uninvolved limb's strength may present as a "moving target" that requires consistent monitoring during rehabilitation. J Orthop Sports Phys Ther 2024;54(4):1-9. Epub 14 December 2023. doi:10.2519/jospt.2023.11961 .

Background: After Anterior Cruciate Ligament Reconstruction (ACLR) athletes face the challenge of regaining their previous competitive level while avoiding re-injury and early knee joint cartilage degeneration. Quadriceps and hamstrings strength reductions and neuromuscular alterations potentially related to risk of re-injury are present after ACLR and relate to deficits in muscle activation., Design: Cross-sectional laboratory study., Purpose: To examine quadriceps and hamstrings muscle activation during repeated hops in healthy pivoting-sport athletes and those who had undergone ACLR (bone-tendon-bone and semitendinosus graft) who had met functional criteria allowing return to training., Methods: Surface electromyography (SEMG) was recorded from vastus medialis and lateralis and medial and lateral hamstrings bilaterally during 30 seconds' repeated hopping in male athletes on average eight months after ACLR surgery (5-12 months). All patients underwent hamstring (HS) (n=24) or bone-tendon-bone (BTB) reconstruction (n=20) and were compared to healthy controls (n=31). The SEMG signals were normalized to those obtained during maximal voluntary isometric contraction., Results: A significant time shift in peak muscle activation (earlier) was seen for: vastus medialis and vastus lateralis activation in the control group, in the BTB group's healthy (but not injured) leg and both legs of the HS group. A significant time shift in peak muscle activation was seen for lateral hamstrings (earlier) in all but the BTB group's injured leg and the medial hamstrings in the control group only. Lower peak activation levels of the vastus lateralis (p\<0.001) and vastus medialis (p\<0.001) were observed in the injured compared to healthy legs and lower peak lateral hamstrings activity (p\<0.009) in the injured leg compared to control leg. Decline in medial hamstring peak activation (p\<0.022) was observed between 1 st and 3 rd phase of the hop cycle in all groups., Conclusion: Repeated hop testing revealed quadriceps and hamstring activation differences within ACLR athletes, and compared to healthy controls, that would be missed with single hop tests., Level of Evidence: 3., Competing Interests: The authors declare no conflicts of interest., (© The Author(s).)

Purpose: To determine the diagnostic value of seven injury history variables, nine clinical tests (including the combination thereof) and overall clinical suspicion for complete discontinuity of the lateral ankle ligaments in the acute (0-2 days post-injury) and delayed setting (5-8 days post-injury)., Methods: All acute ankle injuries in adult athletes (≥18 years) presenting up to 2 days post-injury were assessed for eligibility. Athletes were excluded if imaging studies demonstrated a frank fracture or 3 T MRI could not be acquired within 10 days post-injury. Using standardized history variables and clinical tests, acute clinical evaluation was performed within 2 days post-injury. Delayed clinical evaluation was performed 5-8 days post-injury. Overall, clinical suspicion was recorded after clinical evaluation. MRI was used as the reference standard., Results: Between February 2018 and February 2020, a total of 117 acute ankle injuries were screened for eligibility, of which 43 were included in this study. Complete discontinuity of lateral ankle ligaments was observed in 23 (53%) acute ankle injuries. In the acute setting, lateral swelling had 100% (95% confidence interval [CI]: 82-100) sensitivity, haematoma had 85% (95% CI: 61-96) specificity and the anterior drawer test had 100% (95% CI: 77-100) specificity. In the delayed setting, sensitivity for the presence of haematoma improved from 43% (95% CI: 24-65) to 91% (95% CI: 70-98; p < 0.01) and the sensitivity of the anterior drawer test improved from 21% (95% CI: 7-46) to 61% (95% CI: 39-80; p = 0.02). Clinical suspicion had a positive likelihood ratio (LR) of 4.35 (95% CI: 0.55-34.17) in the acute setting and a positive LR of 6.09 (95% CI: 1.57-23.60) in the delayed setting., Conclusions: In the acute setting, clinical evaluation can exclude complete discontinuity (e.g., absent lateral swelling) and identify athletes with a high probability of complete discontinuity (e.g., positive anterior drawer test) of the lateral ankle ligaments. In the delayed setting, the sensitivity of common clinical findings increases resulting in an improved diagnostic accuracy. In clinical practice, this study underlines the importance of meticulous clinical evaluation in the acute setting., Level of Evidence: Level III., (© 2024 The Authors. Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Context: The knee, low back, and shoulder account for most overuse injuries in volleyball. Previous researchers have used methodology that did not examine the extent of injury burden and effect on performance., Objective: To develop a more accurate and complete understanding regarding the weekly prevalence and burden of knee, low back, and shoulder problems within the highest levels of men's volleyball, including the role that preseason complaints, match participation, player position, team, and age have on complaints., Design: Descriptive epidemiology study., Setting: Professional volleyball clubs and the National Collegiate Athletic Association Division I program., Patients or Other Participants: A total of 75 male volleyball players, representing 4 teams playing in their country's respective premier league (Japan, Qatar, Turkey, and the United States), participated over a 3-season period., Main Outcome Measure(s): Players completed a weekly questionnaire (Oslo Sports Trauma Research Centre Overuse Injury Questionnaire) reporting pain related to their sport and the extent to which knee, low back, and shoulder problems affected participation, training volume, and performance. Problems leading to moderate or severe reductions in training volume or performance or the inability to participate were considered substantial problems., Results: The mean weekly prevalence of knee, low back, and shoulder problems based on 102 player-seasons was 31% (95% CI = 28%, 34%), 21% (95% CI = 18%, 23%), and 19% (95% CI = 18%, 21%), respectively. Most players (93%, 95/102 player-seasons) reported some level of knee (79%, n = 81/102 player-seasons), low back (71%, n = 72/102 player-seasons), or shoulder (67%, n = 68/102 player-seasons) complaints during the season. Most players (58%, n = 59/102 player-seasons) experienced at least 1 episode of substantial problems affecting the knee (33%, n = 34/102 player-seasons), low back (27%, n = 28/102 player-seasons), or shoulder (27%, n = 28/102 player-seasons). Players with preseason complaints had more in-season complaints than teammates without preseason problems (mean weekly prevalence: knee, 42% versus 8%, t49 = -18.726, P < .001; low back, 34% versus 6%, t32 = -12.025, P < .001; shoulder, 38% versus 8%, t30 = -10.650, P < .001)., Conclusion: Nearly all included elite male volleyball players experienced knee, low back, or shoulder problems, and most had at least 1 bout that substantially reduced training participation or sport performance. These findings suggest that knee, low back, and shoulder problems result in greater injury burden than previously reported., (© by the National Athletic Trainers’ Association, Inc.)