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The Bone & Joint Journal Oct 2023The anterior cruciate ligament (ACL) is frequently injured in elite athletes, with females up to eight times more likely to suffer an ACL tear than males. Biomechanical...
The anterior cruciate ligament (ACL) is frequently injured in elite athletes, with females up to eight times more likely to suffer an ACL tear than males. Biomechanical and hormonal factors have been thoroughly investigated; however, there remain unknown factors that need investigation. The mechanism of injury differs between males and females, and anatomical differences contribute significantly to the increased risk in females. Hormonal factors, both endogenous and exogenous, play a role in ACL laxity and may modify the risk of injury. However, data are still limited, and research involving oral contraceptives is potentially associated with methodological and ethical problems. Such characteristics can also influence the outcome after ACL reconstruction, with higher failure rates in females linked to a smaller diameter of the graft, especially in athletes aged < 21 years. The addition of a lateral extra-articular tenodesis can improve the outcomes after ACL reconstruction and reduce the risk of failure, and it should be routinely considered in young elite athletes. Sex-specific environmental differences can also contribute to the increased risk of injury, with more limited access to and availablility of advanced training facilities for female athletes. In addition, football kits are designed for male players, and increased attention should be focused on improving the quality of pitches, as female leagues usually play the day after male leagues. The kit, including boots, the length of studs, and the footballs themselves, should be tailored to the needs and body shapes of female athletes. Specific physiotherapy programmes and training protocols have yielded remarkable results in reducing the risk of injury, and these should be extended to school-age athletes. Finally, psychological factors should not be overlooked, with females' greater fear of re-injury and lack of confidence in their knee compromising their return to sport after ACL injury. Both intrinsic and extrinsic factors should be recognized and addressed to optimize the training programmes which are designed to prevent injury, and improve our understanding of these injuries.
Topics: Humans; Male; Female; Anterior Cruciate Ligament Injuries; Return to Sport; Anterior Cruciate Ligament; Knee Joint; Athletes
PubMed: 37777208
DOI: 10.1302/0301-620X.105B10.BJJ-2023-0881.R1 -
The American Journal of Sports Medicine Aug 2023
Topics: Humans; Anterior Cruciate Ligament; Knee Joint; Anterior Cruciate Ligament Injuries
PubMed: 37525951
DOI: 10.1177/03635465231186404 -
The Journal of the American Academy of... Aug 2023Midcarpal instability (MCI) of the wrist represents multiple distinct clinical entities that all have in common abnormal force transmission across the midcarpal joint....
Midcarpal instability (MCI) of the wrist represents multiple distinct clinical entities that all have in common abnormal force transmission across the midcarpal joint. This can be asymptomatic but can also result in painful wrist motion, a characteristic catch-up clunk, and symptoms of instability. The carpus is stabilized by numerous extrinsic and intrinsic ligaments. Dynamic joint reactive forces between the proximal and distal carpal rows help create reciprocal motion, which results in smooth, physiologic wrist mechanics. Diagnosis of MCI requires a thorough history, physical examination, and adequate imaging. MCI can be managed nonsurgically with activity modification, physical therapy, specialized orthotics, medications, and corticosteroid injections. A variety of surgical treatment options exists to treat symptomatic MCI. These include arthroscopic thermal capsulorrhaphy, ligament repair or reconstruction, radial osteotomies, and limited radiocarpal or intercarpal fusions. Capsulorrhaphy or ligament repair is favored for mild to moderate cases; osteotomies can be used for the correction of bony deformities contributing to instability, whereas partial wrist arthrodesis is indicated for severe or recurrent instability and fixed deformities.
Topics: Humans; Joint Instability; Ligaments, Articular; Wrist Joint; Carpal Joints; Carpal Bones
PubMed: 37105177
DOI: 10.5435/JAAOS-D-22-00777 -
The Journal of Knee Surgery Jan 2024The intercondylar notch of the knee is a relatively small area. However, numerous rare pathologies can arise in this region. A majority of the existing literature has... (Review)
Review
The intercondylar notch of the knee is a relatively small area. However, numerous rare pathologies can arise in this region. A majority of the existing literature has focused on the cruciate ligament injuries, yet there are several other entities that can cause knee pain from within the intercondylar notch. This review focuses on identifying the various diagnostic and treatment options for rare benign and malignant lesions including ganglion cyst formation, mucoid degeneration, benign proliferative conditions, and intra-articular tumors. These entities are most often diagnosed with advanced imaging studies and treated arthroscopically. While rare, these pathologies are important to identify in patients with ongoing vague knee pain.
Topics: Humans; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Knee Joint; Knee; Magnetic Resonance Imaging; Pain
PubMed: 36539213
DOI: 10.1055/a-2001-6764 -
The American Journal of Sports Medicine Mar 2024
Topics: Humans; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Menisci, Tibial
PubMed: 38426230
DOI: 10.1177/03635465241230333 -
The American Journal of Sports Medicine Feb 2024
Topics: Humans; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Knee Joint
PubMed: 38426314
DOI: 10.1177/03635465231222024 -
Journal of Shoulder and Elbow Surgery Feb 2024Although lateral elbow pain and medial ulnar collateral ligament injury are common musculoskeletal pathologies in overhead athletes, the evidence supporting specific... (Review)
Review
Although lateral elbow pain and medial ulnar collateral ligament injury are common musculoskeletal pathologies in overhead athletes, the evidence supporting specific interventions for managing these conditions is scarce. Management of these conditions has been guided mostly by expert opinion rather than empirical evidence, yet the lack of comparative data in the literature has not negatively affected return-to-play rates following surgery. However, an understanding of what is known regarding unimodal and multimodal treatments for lateral elbow pain and medial ulnar collateral ligament injury is needed for clinicians to select evidence-based treatment pathways and highlight what is not known to develop future high-quality investigations.
Topics: Humans; Elbow; Collateral Ligaments; Elbow Joint; Athletic Injuries; Collateral Ligament, Ulnar; Arthralgia; Pain; Baseball; Ulnar Collateral Ligament Reconstruction
PubMed: 37648014
DOI: 10.1016/j.jse.2023.07.034 -
The Journal of Hand Surgery Dec 2023Intervention for scapholunate instability is aimed at halting the degenerative process by restoring ligament integrity and normalizing carpal kinematics. Part 1 of this... (Review)
Review
Intervention for scapholunate instability is aimed at halting the degenerative process by restoring ligament integrity and normalizing carpal kinematics. Part 1 of this Current Concepts article reviewed the anatomy, kinematics, and biomechanical properties of the scapholunate ligament as well as its critical stabilizers. In this section, we provide a foundation for understanding the spectrum of scapholunate ligament instability and incorporate meaningful new anatomical insights that influence treatment considerations. These updates clarify the importance of the critical stabilizers of the scapholunate interval, ligament-specific considerations in scapholunate ligament reconstruction, and the risks of ligament disinsertion when surgically exposing the dorsal wrist. We propose a ligament-based treatment algorithm based on the stage of injury, degree and nature of ligament damage, and presence of arthritic changes.
Topics: Humans; Scaphoid Bone; Lunate Bone; Joint Instability; Wrist Joint; Ligaments, Articular
PubMed: 37578401
DOI: 10.1016/j.jhsa.2023.06.016 -
Hand Clinics Aug 2023Scapholunate and lunotriquetral instability are common causes of chronic, debilitating wrist pain and functional impairment. In the setting of subacute or chronic... (Review)
Review
Scapholunate and lunotriquetral instability are common causes of chronic, debilitating wrist pain and functional impairment. In the setting of subacute or chronic injuries with predynamic or dynamic instability, the ideal surgical approach remains unclear. In January 2020 the authors started enrolling patients with predynamic and dynamic instability in an Institutional Review Board-approved prospective study, aimed at meticulously studying outcomes using the all-dorsal InternalBrace reconstruction technique. The all-dorsal technique described herein is straightforward, efficient, and easy to learn, with early outcomes equivalent or superior to those of other techniques.
Topics: Humans; Lunate Bone; Prospective Studies; Joint Instability; Wrist Joint; Ligaments, Articular
PubMed: 37453765
DOI: 10.1016/j.hcl.2023.02.008 -
Hand Clinics Aug 2023Ligamentous injuries in the hand and wrist are often underdiagnosed and can present with significant functional limitations if there is untimely recognition of injury.... (Review)
Review
Ligamentous injuries in the hand and wrist are often underdiagnosed and can present with significant functional limitations if there is untimely recognition of injury. Adequate repair or reconstruction is critical in restoring joint stability and mobility. The purpose of this review is to provide an overview of the metacarpophalangeal joint, scapholunate interosseous ligament (SLIL), and non-SLIL carpal ligament anatomy, diagnosis, imaging, treatment consideration and options, as well as surgical techniques encompassing repair, reconstruction, and fusion.
Topics: Humans; Wrist; Ligaments, Articular; Wrist Joint; Upper Extremity; Wrist Injuries; Thumb; Metacarpophalangeal Joint
PubMed: 37453764
DOI: 10.1016/j.hcl.2023.03.002