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Purpose: To report objective measures utilized to assess readiness to return to sport after shoulder instability procedures. Methods: Our systematic review included studies if they assessed active individuals after a shoulder instability procedure with at least 1 patient-reported outcome or physical performance measure. We excluded studies of atraumatic instability, studies only reporting imaging, or studies of biomechanics. Risk of bias was assessed with the Methodological Items for Non-Randomized Studies tool, and studies were further scored with the Return to Sport Value Assessment. Results: Thirty-seven articles selected for inclusion scored a median of 18.5 (comparative) and 10.0 (noncomparative) on the Methodological Items for Non-Randomized Studies and a mean of 2.5 on the Return to Sport Value Assessment. Twelve patient-reported outcomes were utilized across 19 studies to assess pain, function, and psychological readiness, with the Western Ontario Shoulder Index and the Shoulder Instability Return to Sport Index reported most frequently. Eighteen studies reported strength, most commonly internal and external rotation, and 18 studies reported range of motion. Physical performance tests, 6 discrete tests and 1 composite score, were less frequently reported (8 studies), with the Closed Kinetic Chain Upper Extremity Stability Test, Y-Balance Test of the Upper Quarter, and Unilateral Seated Shot-Put Test reported in more than 1 study. Deficits in patient-reported outcomes and limb symmetry persisted at the time of return to sport. Conclusions: Most patients undergoing shoulder stabilization procedures regained fundamental strength and range of motion. However, some studies noted difficulties in achieving sufficient performance metrics for athletic activities 6 months postsurgery. Due to lack of standardized measures, recommendations for specific test components and benchmark data for clinical decision-making are not available. Level of Evidence: Level IV, systematic review of Level III and IV studies.

Introduction: Articular cartilage injuries of the knee are a complex and challenging clinical pathology. Objectives: The purpose of this study was to establish consensus statements via a Delphi process on rehabilitation and return to play (RTP) following knee cartilage injuries. Methods: A consensus process on knee cartilage injuries utilizing a modified Delphi technique was conducted. Seventy-nine surgeons across 17 countries participated in these consensus statements. Eleven questions were generated on rehabilitation and RTP, with 3 rounds of questionnaires and final voting occurring. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was defined as 100% agreement with a proposed statement. Results: Of the 11 total questions and consensus statements on rehabilitation and RTP developed from 3 rounds of voting, 0 achieved unanimous consensus, 2 achieved strong consensus, 4 achieved consensus, and 5 did not achieve consensus. Conclusions: The statements achieving consensus were related to the benefits of early motion and that concomitant procedures may alter the rehabilitation process. RTP following cartilage-related procedures typically follows a rehabilitation guideline largely dependent on the type of cartilage procedure. The statements that did not reach a consensus were related to specific timing to meet goals.

Introduction: Lacrosse has become an increasingly popular sport in recent decades with more players competing at the high school and collegiate levels. Along with the rise in popularity, lacrosse has also seen an increase in and evolution of common injuries experienced by players. Specifically, the incidence of shoulder instability episodes in lacrosse players has continued to increase over the years leading to a progressive focus in further understanding shoulder injuries in lacrosse. Objectives: Despite this recent focus, there remains a lack of substantial data regarding shoulder instability as it relates to lacrosse. Therefore, the objective of this study was to conduct an extensive literature review and provided an overview of many of the most recent concepts discussed surrounding shoulder instability in lacrosse players. Methods: Pubmed and Scopus databases were reviewed for relevant literature pertaining to the diagnosis, treatment, and rehabilitation of contact athletes with shoulder instability. Conclusion: Lacrosse players are at risk for shoulder instability due to the nature of the game. The biomechanics and contact aspect of the sport place a unique stress on the shoulder. Thus, there is an appropriate emphasis on how clinicians understand, diagnose, and treat shoulder instability in lacrosse players. This rise in popularity means every clinician involved in the treatment of athletes should be proficient in performing physical exam components specific to shoulder instability, develop their own treatment approach, and understand commonly used test batteries for determining an athlete...s return to sport.

Introduction: The annual incidence of sport-related concussion ranges from 1.6 to 3.8 million concussions per year representing a common injury in sports. Lacrosse is a rapidly growing sport for both men and women and these athletes are at risk for concussion. The mechanism of injury for concussion in the men's and women's game are different as are the rules and equipment requirements. Objectives: To report the epidemiology, pathophysiology, presentation, and management of sport-related concussion and to highlight recent rule changes for men's and woman's lacrosse in regards to concussion prevention. Methods: PubMed and Scopus databases were searched. All levels of evidence (I-IV) pertaining to concussions in men's and women's lacrosse players were analyzed and presented in this narrative review. Results: For all high school boys’ sports, lacrosse ranks number 3 for sports with the highest prevalence of concussions. Concussions most frequently result from athlete-to-athlete contact which represents 66.4% of the recorded concussions. For all high school girls’ sports, lacrosse ranks number 2 for sports with the highest prevalence of concussions. In women's lacrosse, stick or ball contact with the athlete's head is the most common mechanism of concussion, accounting for 72.7% of the recorded concussions. Conclusions: Both men's and women's lacrosse players are at risk for concussion, even though there are different mechanisms for this injury between the 2 games. Sports medicine providers should be knowledgeable on diagnosis, management and prevention when caring for lacrosse players. Protective equipment and rule changes are potential means to continue to protect these athletes and still need further investigation.

ABSTRACT: Introduction: Acute ankle sprains are one of the most common lower extremity injuries sustained by athletes and it is particularly common in sports such as lacrosse. The majority of ankle sprains affect the lateral ligaments; however, injuries can also occur to the medial ankle and the syndesmosis ligaments, commonly referred to as high ankle sprains. Objectives: The purpose of this review is to provide an overview of the management of ankle injuries in lacrosse players. Methods: Review of current literature was conducted using PubMed, Google Scholar, Cochrane Library, and Ovid. All published English articles related to ankle injuries in athletes, in particular soccer players, were selected. Results: Despite its high prevalence, a significant proportion of athletes experience residual symptoms and recurrence of injury, prolonging their ability to safely return to sport. Depending on the severity of injury, management often includes rehabilitation with conservative modalities, such as rest, ice, compression, elevation therapy, and adjunctive treatments like bracing, immobilization, and foot orthotics. Severe or refractory cases may warrant operative intervention. There remains significant emphasis on the importance of the rehabilitation process, regardless of whether conservative or surgical management is pursued. Conclusions: The decision to return to sport can be challenging and should involve a multidisciplinary approach, with the knowledge that there is a high rate of residual symptoms and injury recurrence.

The athlete with shoulder instability poses a unique challenge to the sports medicine team. Clinical studies support surgical intervention followed by a phased approach to rehabilitation. In the latter phases, it is important to tailor this program to the individual’s specific athletic needs, which requires ongoing qualitative assessment and objective measurement. Passing a return-to-sport testing battery has been shown to decrease the risk of recurrent instability. What is lacking in the literature is a consensus for how to best measure shoulder performance when the required athletic demands are widely varied by hand dominance, sport played, and playing position. Multiple upper-extremity tests have been described in the literature, but there is no consensus on which tests should be used to direct rehabilitation and to safely return the athlete to unrestricted athletic exposure. Using available evidence, we suggest a framework for return-to-play testing that integrates traditional rehabilitation phases with performance testing and graduated sports exposure. Level of Evidence: Level V, expert opinion.

Proximal hamstring injuries are common, and open surgical repair with suture anchors has been the gold standard when surgical intervention is warranted. Endoscopic techniques offer the opportunity of surgical repair with smaller incisions to limit complications and expedite rehabilitation. The purpose of this technique guide is to describe a modified endoscopic technique that allows a safe and anatomic repair of proximal hamstring injuries. The patient is positioned prone with the feet at the head of the bed, table in reverse Trendelenburg, and knees flexed to 90°. Four portals are used, 3 in horizontal alignment within the gluteal fold and 1 directly superior to the ischial tuberosity. The sciatic nerve is identified, dissected, and mobilized away from the operative field. Retraction sutures help retract the gluteus maximus and further protect the sciatic nerve. Dissection is within the interval between the conjoint and semimembranosus tendons. The tendons are freed and mobilized, the ischial tuberosity is decorticated, and an anatomic repair is performed via 4 suture anchors, 2 at each tendon footprint. Advancements in arthroscopy have permitted adequate visualization and exposure of the hamstring footprint, thus allowing for an anatomic repair with increased protection of the sciatic nerve and decreased resources and cost.