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Purpose This study aimed to identify independent predictive factors for return to sports (RTS) after anterior cruciate ligament (ACL) reconstruction in competitive-level athletes and to determine optimal cut-off values for these factors at 6 months after surgery. Methods A total of 124 competitive athletes (50 males and 74 females; mean age, 17.0 years; preinjury Tegner activity scale > 7) who underwent primary ACL reconstruction were enrolled. Assessments at 6 months after surgery consisted of knee functional tests [quadriceps index, hamstrings index, and single-leg hop for distance (SLH)] and 2 self-report questionnaires [IKDC subjective score and ACL-Return to Sport after Injury scale (ACL-RSI)]. At 1 year after surgery, athletes were classified into the RTS group ( n  = 101) or non-RTS group ( n  = 23) based on self-reported sports activities. After screening possible predictive factors of RTS, multivariate logistic regression and receiver operating characteristic curve analyses were performed to identify independent factors. Results Multivariate logistic regression analysis identified SLH (odds ratio, 2.861 per 10 unit increase; P  < 0.001) and ACL-RSI (odds ratio, 1.810 per 10 unit increase; P  = 0.001) at 6 months as independent predictors of RTS at 1 year after surgery. Optimal cut-off values of SLH and ACL-RSI were 81.3% (sensitivity = 0.891; specificity = 0.609) and 55 points (sensitivity = 0.693; specificity = 0.826), respectively. Conclusion In competitive athletes, SLH < 81% and ACL-RSI < 55 points at 6 months after surgery were associated with a greater risk of unsuccessful RTS at 1 year after surgery. SLH and ACL-RSI at 6 months could serve as screening tools to identify athletes who have difficulties with returning to sports after ACL reconstruction. Level of evidence III.

Purpose This systematic review and meta-analysis aimed to (1) determine the proportion of patients who underwent anterior shoulder instability surgery and did not return to sports for psychological reasons and (2) estimate differences in psychological readiness scores between patients who did and did not return to sports. Methods The EBSCOhost/SPORTDiscus, PubMed/Medline, Scopus, EMBASE and Cochrane Library databases were searched for relevant studies. The data synthesis included the proportion of patients who did not return to sports for psychological reasons and the mean differences in the psychological readiness of athletes who returned and those who did not return to sports. Non-binomial data were analysed using the inverse-variance approach and expressed as the mean difference with 95% confidence intervals. Results The search yielded 700 records, of which 13 (1093 patients) were included. Fourteen psychological factors were identified as potential causes for not returning to sports. The rates of return to sports at any level or to the preinjury level were 79.3% and 61.9%, respectively. A total of 55.9% of the patients cited psychological factors as the primary reason for not returning to sports. The pooled estimate showed that patients who returned to sports had a significantly higher Shoulder Instability-Return to Sport After Injury score ( P  < 0.00001) than those who did not, with a mean difference of 30.24 (95% CI 24.95–35.53; I 2  = 0%; n.s.). Conclusions Psychological factors have a substantial impact on the rate of return to sports after anterior shoulder instability surgery. Patients who returned to sports had significantly higher psychological readiness than those who did not return to sports. Based on these results, healthcare professionals should include psychological and functional measurements when assessing athletes’ readiness to return to sports. Level of evidence Level IV.

Purpose The aim of this study is to report the effects of autologous PRP injections on time to return to play and recurrence rate after acute grade 2 muscle injuries in recreational and competitive athletes. Methods Seventy-five patients diagnosed with acute muscle injuries were randomly allocated to autologous PRP therapy combined with a rehabilitation programme or a rehabilitation programme only. The primary outcome of this study was time to return to play. In addition, changes in pain severity and recurrence rates were evaluated. Results Patients in the PRP group achieved full recovery significantly earlier than controls ( P  = 0.001). The mean time to return to play was 21.1 ± 3.1 days and 25 ± 2.8 days for the PRP and control groups, respectively ( P  = 0.001). Significantly lower pain severity scores were observed in the PRP group throughout the study. The difference in the recurrence rate after 2-year-follow-up was not statistically significant between groups. Conclusions A single PRP injection combined with a rehabilitation programme significantly shortened time to return to sports compared to a rehabilitation programme only. Recurrence rate was not significantly different between groups. Level of evidence I.

Purpose The anterior cruciate ligament-return to sports after injury (ACL-RSI) scale assesses the psychological impact of returning to sports (also referred to as psychological readiness) after ACL reconstruction. The aim of this study was to evaluate important measurement properties of the Japanese version of ACL-RSI scale. Methods Ninety-three participants who underwent ACL reconstruction filled out the Japanese version of ACL-RSI scale, the Tampa scale for kinesiophobia (TSK), the International Knee Documentation Committee-Subjective Knee Form (IKDC-SKF), and Knee injury and Osteoarthritis Outcome Score (KOOS). To assess test re-test reliability, 50 of the 93 participants re-answered the Japanese version of ACL-RSI scale within 10 days. Floor and ceiling effects, internal consistency, construct validity, and reliability of the Japanese version of ACL-RSI scale were analysed. Results There were no floor and ceiling effects. The Japanese version of ACL-RSI scale showed good internal consistency (Cronbach’s alpha = 0.912). It was positively correlated with total points of IKDC-SKF and the Lysholm score, and with the all sub-categories of the KOOS, and it was negatively correlated with the TSK. Reliability of the Japanese version of ACL-RSI scale was satisfactory. Conclusion The Japanese version of ACL-RSI scale has acceptable measurement properties. It can be a useful for evaluation of psychological readiness for return to sports in Japanese athletes who undergo primary ACL reconstruction. Information provided by the Japanese version of the ACL-RSI scale may also help to identify athletes who find return to sport a challenge, and guide conversations regarding treatment and rehabilitation plans. Level of evidence II.

BackgroundTo evaluate the efficacy of a single platelet-rich plasma (PRP) injection in reducing the return to sport duration in male athletes, following an acute hamstring injury.MethodsA randomised, three-arm (double-blind for the injection arms), parallel-group trial, in which 90 professional athletes with MRI positive hamstring injuries were randomised to injection with PRP-intervention, platelet-poor plasma (PPP-control) or no injection. All received an intensive standardised rehabilitation programme. The primary outcome measure was time to return to play, with secondary measures including reinjury rate after 2 and 6 months.ResultsThe adjusted HR for the PRP group compared with the PPP group was 2.29 (95% CI 1.30 to 4.04) p=0.004; for the PRP group compared with the no injection group 1.48 (95% CI 0.869 to 2.520) p=0.15, and for the PPP group compared with the no injection group 1.57 (95% CI 0.88 to −2.80) p=0.13. The adjusted difference for time to return to sports between the PRP and PPP groups was −5.7 days (95% CI −10.1 to −1.4) p=0.01; between the PRP and no injection groups −2.9 days (95% CI −7.2 to 1.4) p=0.189 and between the PPP and no injection groups 2.8 days (95% CI −1.6 to 7.2) p=0.210. There was no significant difference for the secondary outcome measures. No adverse effects were reported.ConclusionsOur findings indicate that there is no benefit of a single PRP injection over intensive rehabilitation in athletes who have sustained acute, MRI positive hamstring injuries. Intensive physiotherapy led rehabilitation remains the primary means of ensuring an optimal return to sport following muscle injury.Trial registration numberClinicalTrials.gov Identifier: NCT01812564.

Psychological readiness to return to sport has been shown to be associated with future play after anterior cruciate ligament (ACL) reconstruction surgery but has not been extensively studied in adolescent athletes. To investigate the psychometric properties of the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale in adolescent athletes at multiple time points after ACL reconstruction surgery and determine whether psychological readiness scores at 6 months predict return to competition sport at 12 months. Case series. Private orthopaedic clinic. A total of 115 adolescent athletes (65 girls, 50 boys) 17 years and younger who had undergone primary unilateral ACL reconstruction. The ACL-RSI scale was administered at 6 and 12 months after surgery, and return-to-sport status was also documented. Factor analysis was undertaken and predictive validity assessed using between-groups comparisons and receiver operating characteristic (ROC) curve statistics. The ACL-RSI scores increased between 6 and 12 months (55 to 71; P < .001, effect size = 0.98). No floor or ceiling effects were present, and the scale had high internal consistency (Cronbach α at 6 months = 0.91 and at 12 months = 0.94). Principal component analysis showed that 2 factors were present: the first represented performance confidence and risk appraisal and the second, emotions. For the full-scale ACL-RSI, scores at 6 months had acceptable predictive ability for a return to play at 12 months (area under the ROC curve = 0.7, P = .03). When the 2 identified factors were analyzed separately, the emotions factor also had acceptable predictive ability (area under the ROC curve = 0.73, P = .009), but the confidence in performance and risk appraisal factors had poor predictive ability (area under the ROC curve = 0.59, P = .09). Greater psychological readiness was associated with return to sport in adolescent athletes after ACL reconstruction, with the athletes' emotional response appearing to be more influential than their confidence in their performance or their appraisal of risk.

Purpose Autologous chondrocyte implantation is an established method for the treatment of joint cartilage damage. However, to date it has not been established that autologous chondrocyte implantation is an appropriate procedure for cartilage defects therapy in athletic persons. The aim of this study is to analyze if third-generation autologous chondrocyte implantation is an appropriate treatment for athletic persons with full cartilage defect of the knee joints. Methods A total of 84 patients were treated with third-generation autologous chondrocyte implantation (NOVOCART ® 3D). The mean follow-up time was 8 years (5–14). Sports activity was measured via UCLA Activity Score and Tegner Activity Scale before the onset of knee pain and postoperatively in an annual clinical evaluation. 41 athletic persons and 43 non-athletic persons (UCLA-Cut-off: 7; Tegner Activity Scale-Cut-off: 4) were analyzed. Patient reported outcomes were captured using IKDC subjective, KOOS, Lysholm score and VAS score on movement. Results Patient reported outcomes (IKDC, VAS at rest, VAS on movement) showed significant improvement ( p  < 0.001) postoperatively. Athletic persons demonstrated significantly better results than non-athletic persons in the analyzed outcome scores (IKDC: p  < 0.01, KOOS: p  < 0.01, Lysholm score: p  < 0.01). 96.4% of the patients were able to return to sport and over 50% returned or surpassed their preinjury sports level. The remaining patients were downgraded by a median of two points on the UCLA- and 2.5 on the Tegner Activity Scale. A shift from high-impact sports to active events and moderate or mild activities was found. Furthermore, it was shown that preoperative UCLA score and Tegner Activity Scale correlated significantly with the patient reported outcome postoperatively. Conclusion Autologous chondrocyte implantation is a suitable treatment option for athletic persons with full-thickness cartilage defects in the knee. The return to sports activity is possible, but includes a shift from high-impact sports to less strenuous activities.

Background/aimTo compare outcome of early mobilisation and plaster immobilisation in patients with a simple elbow dislocation. We hypothesised that early mobilisation would result in earlier functional recovery.MethodsFrom August 2009 to September 2012, 100 adult patients with a simple elbow dislocation were enrolled in this multicentre randomised controlled trial. Patients were randomised to early mobilisation (n=48) or 3 weeks plaster immobilisation (n=52). Primary outcome measure was the Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score. Secondary outcomes were the Oxford Elbow Score, Mayo Elbow Performance Index, pain, range of motion, complications and activity resumption. Patients were followed for 1 year.ResultsQuick-DASH scores at 1 year were 4.0 (95% CI 0.9 to 7.1) points in the early mobilisation group versus 4.2 (95% CI 1.2 to 7.2) in the plaster immobilisation group. At 6 weeks, early mobilised patients reported less disability (Quick-DASH 12 (95% CI 9 to 15) points vs 19 (95% CI 16 to 22); p<0.05) and had a larger arc of flexion and extension (121° (95% CI 115° to 127°) vs 102° (95% CI 96° to 108°); p<0.05). Patients returned to work sooner after early mobilisation (10 vs 18 days; p=0.020). Complications occurred in 12 patients; this was unrelated to treatment. No recurrent dislocations occurred.ConclusionsEarly active mobilisation is a safe and effective treatment for simple elbow dislocations. Patients recovered faster and returned to work earlier without increasing the complication rate. No evidence was found supporting treatment benefit at 1 year.Trial registration numberNTR 2025.

Shoulder instability is a common injury in athletes that often requires surgical stabilization. While RTS rates after shoulder stabilization may be around 81%, approximately 19-52% of athletes do not return to their preinjury level of play. Psychological factors like fear of reinjury, lack of motivation, and change in priorities are key barriers to RTS after shoulder surgery. The Shoulder Instability Return to Sport after Injury (SIRSI) scale quantitatively assesses athletes' psychological readiness to return to sport following shoulder stabilization. Higher SIRSI scores correlate with increased likelihood of returning to preinjury level of play. However, current RTS guidelines rely heavily on time-based criteria and lack consensus on assessing psychological readiness. Adopting a more comprehensive approach that incorporates physical and psychological evaluations may better determine athletes' readiness to RTS. Incorporating the SIRSI scale into the RTS decision-making process, alongside physical evaluations, can potentially improve RTS outcomes in athletes after shoulder stabilization surgery. Further research is needed to establish standardized protocols and validate the effectiveness of interventions aimed at optimizing psychological readiness.

ObjectiveTo compare the effectiveness of progressive tendon-loading exercises (PTLE) with eccentric exercise therapy (EET) in patients with patellar tendinopathy (PT).MethodsIn a stratified, investigator-blinded, block-randomised trial, 76 patients with clinically diagnosed and ultrasound-confirmed PT were randomly assigned in a 1:1 ratio to receive either PTLE or EET. The primary end point was clinical outcome after 24 weeks following an intention-to-treat analysis, as assessed with the validated Victorian Institute of Sports Assessment for patellar tendons (VISA-P) questionnaire measuring pain, function and ability to play sports. Secondary outcomes included the return to sports rate, subjective patient satisfaction and exercise adherence.ResultsPatients were randomised between January 2017 and July 2019. The intention-to-treat population (mean age, 24 years, SD 4); 58 (76%) male) consisted of patients with mostly chronic PT (median symptom duration 2 years). Most patients (82%) underwent prior treatment for PT but failed to recover fully. 38 patients were randomised to the PTLE group and 38 patients to the EET group. The improvement in VISA-P score was significantly better for PTLE than for EET after 24 weeks (28 vs 18 points, adjusted mean between-group difference, 9 (95% CI 1 to 16); p=0.023). There was a trend towards a higher return to sports rate in the PTLE group (43% vs 27%, p=0.13). No significant between-group difference was found for subjective patient satisfaction (81% vs 83%, p=0.54) and exercise adherence between the PTLE group and EET group after 24 weeks (40% vs 49%, p=0.33).ConclusionsIn patients with PT, PTLE resulted in a significantly better clinical outcome after 24 weeks than EET. PTLE are superior to EET and are therefore recommended as initial conservative treatment for PT.