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Purpose of ReviewAnterior cruciate ligament reconstruction (ACLR) is a common surgical procedure with an estimated 120,000 cases performed in the USA each year. Physical therapy plays a critical role in the successful recovery of both surgically and non-surgically managed patients. Interestingly, ACL rehabilitation protocols vary greatly with little consensus among practitioners. Nonetheless, there has been agreement over the last decade to shift from conservative, standardized length protocols to more accelerated, individualized protocols that vary in length and modalities based on patient-specific findings and preferences. This review summarizes the most recent trends, opinions, and modalities in ACL rehabilitation research, with a specific focus on novel methods to treat the specific psychosocial needs of ACL deficient patients.Recent FindingsWe found that new protocols emphasize early weight bearing, open kinetic chain (OKC) exercises, and other alternative modalities such as neuromuscular electrical stimulation and blood flow restriction. We also found a recent trend toward the use of clinical milestones to determine when a patient is ready for the next phase of a “step-up” rehabilitation program. One particularly nascent topic of research is the inclusion of methods to treat the psychosocial impacts of ACL injury, recovery, and the anxiety around return to sport.SummaryRehabilitation strategy has become increasingly patient-dependent, and the new modalities being utilized are accelerating patient recovery. Return to sport is a particularly important factor for many ACLR patients, and recovery has an important psychological component that has only recently been addressed in the literature, with positive preliminary findings.

Purpose of ReviewAchilles tendon ruptures (ATR) are detrimental to sports performance, and optimal treatment strategy and guidelines on return to play (RTP) remain controversial. This current review investigates the recent literature surrounding nonoperative versus operative management of ATR, clinical outcomes, and operative techniques to allow the athlete a successful return to their respective sport.Recent FindingsThe Achilles tendon (AT) is crucial to the athlete, as it is essential for explosive activities such as running and jumping. Athletes that sustain an ATR play in fewer games and perform at a lower level of play compared to age-matched controls. Recent studies also theorize that ATRs occur due to elongation of the tendon with fatigue failure. Biomechanical studies have focused on comparing modes of fixation under dynamic loading to recreate this mechanism.SummaryATRs can be career-ending injuries. Fortunately, the recent incorporation of early weight-bearing and functional rehabilitation programming for non-operative and operative patients alike proves to be beneficial. Especially for those treated nonoperatively, with the incorporation of functional rehabilitation, the risk of re-rupture among non-operative patients is beginning to approach the historical lower risk of re-rupture observed among patients treated operatively. Despite this progress in decreasing risk of re-rupture particularly among non-operative patients, operative managements are associated with unique benefits that may be of particular interest for athletes and active individuals. Recent studies demonstrate that operative intervention improves strength and functional outcomes with more efficacy compared to nonoperative management with rehabilitation. The current literature supports operative intervention in elite athletes to improve performance and shorten the duration to RTP. However, we acknowledge that surgical intervention does have inherent risks. Ultimately, most if not all young and/or high-level athletes with an ATR benefit from surgical repair, but it is crucial to take a stepwise algorithmic approach and consider other factors, which may lead towards nonoperative intervention. These factors include age, chronicity of injury, gap of ATR, social factors, and medical history amongst others in this review.

Purpose of ReviewCross-discipline fitness, or CrossFit, has exploded in popularity during the last two decades. During this time, there have been a high volume of patients presenting to clinicians with a wide range of associated injuries. Given the high intensity, high repetition, and competitive nature of CrossFit training and competition, athletes are vulnerable to injury, particularly upper extremity injury. The rate of injury to the shoulder, elbow, and wrist in CrossFit is higher when compared to traditional weight-training and more comparable to elite-level gymnastics and Olympic-style lifting. Due to the growing popularity of CrossFit-style exercise and the relatively high rate of injury among its participants, clinicians are likely to encounter these athletes. The purpose of this review is to familiarize clinicians with CrossFit and the associated injuries they will likely encounter.Recent FindingsThe medical literature focusing on CrossFit has demonstrated exponential growth, with the first article published in 2012 and 59 articles published in 2020. Although the body of literature is growing, there are no high-level studies focusing on CrossFit. The literature mainly consists of level IV and V studies, primarily consisting of case reports and case series. Recent studies have proven that CrossFit athletes are vulnerable to high rates of upper extremity injury and a few studies have identified risk factors for injury. Future high-level research is required to study modifiable risk factors, diagnostic criteria, and treatment options for these high-risk athletes in order to improve the safety of their sport.SummaryThe CrossFit body of research is limited to level IV and V studies; however, the literature is clear, CrossFit athletes face a high rate of upper extremity injury. For this reason, clinicians must be familiar with CrossFit and its associated pathology. The goal of this review is to familiarize clinicians with CrossFit and the associated pathologies they will likely encounter.

Purpose of ReviewThis review presents epidemiology, etiology, management, and surgical outcomes of rotator cuff injuries in tennis players.Recent FindingsRotator cuff injuries in tennis players are usually progressive overuse injuries ranging from partial-thickness articular- or bursal-sided tears to full-thickness tears. Most injuries are partial-thickness articular-sided tears, while full-thickness tears tend to occur in older-aged players. The serve is the most energy-demanding motion in the sport, and it accounts for 45 to 60% of all strokes performed in a tennis match, putting the shoulder at increased risk of overuse injury and rotator cuff tears. Studies have shown deficits in shoulder range of motion and scapular dyskinesia to occur even acutely after a tennis match. First-line treatment for rotator cuff injuries in any overhead athlete consists of conservative non-operative management with appropriate rest, anti-inflammatory drugs, followed by a specific rehabilitation program. Operative treatment is usually reserved for older-aged players and to those who fail to return to play after conservative measures. Surgical options include rotator cuff debridement with or without tendon repair, biceps tenodesis, and labral procedures. Unlike rotator cuff repairs in the general population, repairs in the elite tennis athlete have less than ideal rates of return to sport to the same level of performance.SummaryRotator cuff injuries are a common cause of pain and dysfunction in tennis players and other overhead athletes. The etiology of rotator cuff tears in tennis players is multifactorial and usually results from microtrauma and internal impingement in the younger athlete leading to partial tearing and degenerative full-thickness tears in older players. Surgical treatment is pursued in athletes who are still symptomatic despite an extensive course of non-operative treatment as outcomes with regard to returning to sport to the same pre-injury level are modest at best. Debridement alone is usually preferred over rotator cuff repairs for partial tears in younger players due to potential over-constraining of the shoulder joint and decreased rates of return to sport after rotator cuff repairs.

Purpose of ReviewTo discuss the treatment options and rehabilitation protocols after non-operative and operative treatment of patellar instability, and to discuss expected return to play outcomes and functional performance with non-operative and operative treatment of patellar instability.Recent FindingsA criterion-based program assessing range of motion, joint effusion, strength, neuromuscular control, proprioception, agility, and power are critical measures to assess when rehabilitating this population. A series of functional tests including quadriceps strength testing, single-limb hop testing, lateral step-down test, the side hop test, the lateral leap and catch test, the Y-balance test, and the depth jump should be considered when determining an athlete’s return to sport clearance. These objective measures combined with psychological readiness and a comprehensive understanding of the sports-specific tasks required for participation should be considered when evaluating an athlete’s ability to safely and successfully return to sport.SummaryWe discuss rehabilitation management when working with non-operative and operative management of patellar instability and provide considerations for clinicians working with these athletes to facilitate safe return to sport.

Purpose of Review To assess the current literature surrounding the treatment and rehabilitation strategies surrounding proximal hamstring rupture injuries, along with comparative return to sport and patient-reported outcomes. Recent Findings A high degree of variability exists in protective and rehabilitation strategies after both operative and non-operative proximal hamstring rupture management. Acceptable outcomes after both operative and non-operative management have been observed but may vary greatly with injury chronicity, severity, and surgical technique. Summary The high complication rates observed after surgical treatment, along with poor functional outcomes that may occur in the setting of non-operative treatment or delayed surgery, highlight the importance of early injury evaluation and careful patient selection. Further high-quality research elucidating clearer indications for early operative management and an optimized and standardized rehabilitation protocols may improve outcomes and return to sport experience and metrics for individuals sustaining proximal hamstring ruptures.

Purpose of ReviewThe purpose of this review is to discuss treatment options, rehabilitation protocols, return-to-play criteria, and expected outcomes after non-operative and operative treatment of anterior cruciate ligament (ACL) tears among an athletic population.Recent FindingsNon-operative treatment may be a viable option for some athletes with an ACL tears but can be difficult to predict “copers,” and those that resume to sports return at lower performance level and/or less intense activities. Most studies assessing function after ACL reconstruction demonstrate favorable outcomes using patient-reported outcome studies. However, return-to-play and graft re-rupture rates vary substantially based on patient characteristics and level and type of athletic activity. Grafts used to reconstruct ACL produce similar objective outcomes and favorable patient-reported outcomes but have variable re-rupture rates depending on study and differ largely on morbidity associated with graft harvest.SummaryVarious treatment methods including non-operative and operative techniques have been demonstrated to be efficacious in returning athletes to athletic activity depending on patient age and level of activity. Adherence to fundamental rehabilitation principles and accepted return-to-play guidelines can optimize outcomes and limit re-injury to the injured or contralateral limb.

Purpose of ReviewThis review examines the relationship between the baseball pitching motion and the kinetic chain. The goal was to determine the underlying causes of a deficiency in throwing mechanics throughout a throwing motion, and to provide an evidence-based approach on how to prevent injuries caused by a lack of proper mechanics. In doing so, we sought to provide a warm-up strategy that can be added to every baseball player’s daily on-field routine that is tailored to each phase of the throwing motion.Recent FindingsTo help minimize the risk of injury to overhead throwing athletes, a thorough understanding of the throwing motion is critical. Throwing a ball places extreme stress on the body, notably the shoulder and elbow joints. With a clear understanding of the biomechanics of throwing, we can develop an injury prevention routine to minimize unnecessary stresses throughout the kinetic chain.SummaryThe throwing cycle is a complex motion that places various stresses throughout the thrower’s body, from the ankle to the core, and from the back to the shoulder and elbow. A thorough understanding of the mechanics of this motion, along with specific exercises to target the specific actions of each phase, may allow for throwers, regardless of their age and experience, to minimize injury risk.

Purpose of ReviewPosterior cruciate ligament injuries can be treated conservatively with a structured rehabilitation program or with surgical reconstruction. Treatment algorithms are based on a variety of factors including the patient’s presentation, physical exam, and desired level of activity. The goal is to return the patient to their athletic pursuits with a stable and pain-free knee. Return to play and activities should be individualized based on the patient’s injury and progression through rehabilitation. This article provides a review of the current treatments for posterior cruciate ligament injuries and the respective rehabilitation protocols, outcomes after each treatment option, and specific return to play criteria.Recent FindingsCurrent research shows excellent outcomes and return to play with conservative treatment of isolated posterior cruciate ligament injuries. Return to play algorithms stress the importance of quadriceps strengthening throughout the recovery process and emphasize inclusion of plyometrics and sport-specific training.SummaryRehabilitation plays a critical role in the outcome after posterior cruciate ligament injury and the ability to return to athletics. The primary focus of post-injury or post-operative rehabilitation is to restore function, as it relates to range of motion, strength, and proprioception, while mitigating swelling and pain. The patients’ desired sport and level of play dictate return to play timelines. The literature supports the use of non-operative management of isolated PCL injuries in athletes and non-athletes with excellent functional and patient-reported outcomes.