Functional diagnostics, such as biomechanical testing in orthopaedic patients, is an important and frequently discussed topic in both the literature and clinical practice. It represents a multidisciplinary approach involving medical doctors, physiotherapists, sports scientists, and other disciplines. There is controversy regarding terminology and applications in clinical settings. This article provides an overview of the most common terms and methods. Functional diagnostics are used in the diagnosis of disorders related to human locomotion and functional deficits. The primary focus is on developing and evaluating the effectiveness of prevention or rehabilitation programs. Functional diagnostics are also used to evaluate patients before and after surgeries, such as ACL repair, to assess improvement and outcomes. The Functional Diagnostics Committee of the German Society of Orthopaedic and Traumatological Sports Medicine (Gesellschaft für Orthopädisch-Traumatologische Sportmedizin, "GOTS") has summarized the recent literature in this field and developed a practically based approach for the implementation of functional testing in orthopaedics.

The quality of websites containing medical content is becoming increasingly important as the Internet is a major source of information on health issues and can influence the course of a disease. This study analysed 250 websites on chronic ankle instability, which affects 40% of patients after acute ankle sprain. Based on the results, a guide for patients was developed.The EQIP36 score for medical information materials, along with a 25-item evaluation tool, was used to evaluate the quality of the websites. The reading level was determined by the Flesch-Kincaid index and the calculated readability. A survey of medical laypersons and specialists was conducted to further analyse the top 3 websites.Out of 250 websites surveyed, 42 were included in the analysis, with significant differences in quality observed. None of the websites adequately fulfilled the quality requirements. Websites affiliated with health system sources predominated and demonstrated higher quality, whereas commercially operated sites, as well as those with advertising or links to social media, showed below-average content completeness. None of the websites reached the recommended reading level. The survey showed a mixed level of satisfaction. Participants without prior medical knowledge criticised the use of medical jargon and the inclusion of distressing surgical images.The available online resources for ankle instability are insufficient in quality and lack consistency. Deficits in content, readability and structure impair effective use by patients. Stakeholders involved in publishing health information should prioritise improving its clarity and quality to better support patients in self-managing their health conditions.

To investigate the reliability of elbow flexion and extension strength measurements via a hand-held dynamometer (HHD) in different positions and to determine the minimal detectable change (MDC).Reliability study.Twenty healthy university students were evaluated at an exercise laboratory. Elbow flexion and extension strength were each measured by two physiotherapists in three different positions. Intra-class correlation coefficients (ICCs) were calculated to assess intra-rater reliability (ICC 3,3) and inter-rater reliability (ICC 3,3) and were used to calculate MDC.All measurement procedures have excellent intra- and inter-rater reliability scores in females (0.88-0.98) and males (0.81-0.95), except for moderate intra-rater reliability (0.72) for seated measurement of elbow flexion strength with the shoulder at 90-degree flexion in males. There is a systematic difference in inter-rater results for all flexion positions and intra-rater results for one flexion position in males (p<0.05). MDC95% ranged from 3.44 to 11.69 for intra-rater scores and from 6.19 to10.79 for inter-rater scores.All procedures showed excellent reliability, except for moderate intra-rater reliability in seated measurement of elbow flexion strength with the shoulder at 90-degree flexion in males. However, elbow flexion measurement was prone to systematic differences in males. Muscle strength of the tested individual and testers should be considered.

Hip joint replacement with total hip arthroplasty is a frequently performed and highly successful treatment option that is increasingly being offered to younger patients. Due to their longer life expectancy, the longevity expectations for the endoprosthesis have also increased. Physical activity and sports have a positive effect on the risk of loosening. There is no scientific evidence that participation in any specific sport adversely affects the longevity of a hip endoprosthesis. Nevertheless, recommendations to patients vary widely from surgeon to surgeon, and some types of sport are still generally discouraged. This article provides an overview of both recent and older studies addressing the question "What sports are still permissible with an artificial hip?" It attempts to clarify that high joint forces are not necessarily associated with high risk of damage, as the anatomy of muscles and bones, together with muscle function, is optimised to accomodate higher loads. High forces pose a risk only if they are applied in directions not physiologically intended or if the implant is poorly anchored in the bone. The principle that only sports which can be performed with sufficient coordination should be undertaken is therefore certainly correct. Overall, patients should be encouraged to engage in activities in which they feel comfortable and are aware of their own limitations and risks. Hip resurfacing represents an option for a carefully selected patient population, potentially allowing for a return to elite sports. However, the indication requires careful consideration of the local and systemic risks associated with metal-on-metal articulations, as well as the patient's age and athletic aspirations. The extent to which new developments without a metal-on-metal articulation may allow for an expanded indication must be carefully evaluated. Clear guidance from the surgeon to the patient regarding the timeline and postoperative activity following hip replacement with an H-TEP or hip resurfacing is necessary to support patient confidence.

More than three decades have passed since the German Society for Orthopaedics and Traumatology published its first recommendations on sports participation for scoliosis patients. During this period, surgical techniques have changed more substantially than non-surgical procedures. Confidence in modern pedicle screw constructs for posterior spinal correction and fusion has led to an earlier and more extensive return to sporting activities after corrective surgery, whereas the theoretically plausible advantage of newer, mobility-preserving procedures has not yet been sufficiently proven. At least for elite athletes, a return to pre-operative performance appears achievable even in the short term after surgery. However, the short follow-up periods of many studies on sports participation after scoliosis surgery may lead to an underestimation of the long-term disadvantages of fusions extending into the lumbar spine, as suggested by a Japanese study with a follow-up period of at least 10 years. Potential long-term effects of specific physiotherapeutic approaches, such as Schroth therapy, have not yet been investigated and are therefore not evident.

The PLAY study (Pain, Lesions and Analgesics in Youth and Elite Sports) investigates the extent, patterns and treatment of pain in organised professional sports. This study, presented here for the first time, focused on Olympic weightlifting in this context. As part of a case-control study, weightlifters from the German Olympic squad (OSW, n=35) were compared with matched controls from the general population (n=35) using 1:1 matching for sex, age, and BMI. Validated, field-tested questions and scores were used to record the prevalence of pain, analgesic consumption and willingness to compete despite pain among German elite athletes. Due to the matched pairs design, bivariate associations were examined using McNemar tests. Among the 35 Olympic weightlifters surveyed, 80% (8 out of 10) reported experiencing pain in the past 7 days, with an average of at least 3 regions affected simultaneously, mainly neck, back, head, and knees. With the exception of the back (71% vs. 83%; p>0.05), the 12-month pain prevalence was significantly higher in OSW, especially in the wrists (66% vs. 40%; p=0.035), where the most severe pain occurred (VAS 7.3/10). The use of painkillers was widespread among athletes and controls. Among Olympic weightlifters, the majority of cases involved self-medication. Frequent consumption was mainly found for ibuprofen (20%), acetylsalicylic acid (14%), and diclofenac (9%). The willingness to take part in competitions despite pain was widespread among the top athletes in our sample: 94% stated they would take part even if they needed to take painkillers. In contrast, only 9% reported that they would continue to participate even if their doctors advised against it. Therefore, doctors seem to act as gatekeepers and are most likely able to dissuade athletes from making such risky decisions. Among the athletes studied here at the highest national performance level, high 12-month prevalence rates for joint pain, widespread and, in some cases, prophylactic self-medication with painkillers were observed, along with a strong willingness to compete despite health complaints and pain.

Low back pain is prevalent among both the general population and physically active adolescents. A substantial proportion of cases can be attributed to lumbar bone stress injuries (LBSI), particularly among adolescents engaged in competitive sports, likely due to high physical demands. This study aims to evaluate the prevalence and incidence of LBSI in adolescent athletes, with a focus on sport- and location-specific as well as age- or sex-related differences.A systematic review was conducted using the PubMed and Web of Science databases to identify studies reporting on LBSI in adolescent athletes aged 11 to 19 years. Inclusion criteria focused on MRI-confirmed LBSI. Data synthesis included descriptive statistics, correlation and regression analysis to assess the influence of sport type, age, sex, and injury location on the prevalence and incidence of LBSI.From 188 initially identified articles, nine studies were included in the final analysis, comprising a total of 572 athletes across various sports. The review revealed LBSI prevalence rates ranging from 10.5% to 54% and incidence rates between 21% and 27%. The highest prevalence was observed in "cricket fast bowlers". A strong correlation (r=0.80) was identified between older adolescent age and increased LBSI prevalence, particularly in cricket players. However, the influence of sex could not be adequately analysed due to the limited representation of female athletes. The most frequently reported location of LBSI was the L5 level (24%-86%), followed by L4 (17%-50%), L3 (5%-33%) and L2 (10%-18%), respectively.LBSI is a significant overuse injury among adolescent athletes, particularly in sports that involve repetitive lumbar loading in hyperextension combined with rotation. The findings highlight the need for targeted preventive strategies, focusing on age-related risk and sport-specific demands. Future research should focus on diverse athlete populations, including balanced sex representation, and employ longitudinal designs to better understand the long-term implications of LBSI.

Children with open growth plates should not simply be regarded or managed as "small adults". A thorough understanding of the paediatric knee and its growth, along with the anatomical, hormonal, and neuromuscular changes occurring in children during maturation, is one of the key factors in the diagnosis, decision-making, and monitoring of skeletally immature patients with anterior cruciate ligament (ACL) injuries. Timely and accurate diagnosis and treatment of these ACL injuries are crucial to protecting the long-term integrity of the child's knee with regular reassessments being required to provide each individual patient with the best possible care. In the case of surgical treatment, the surgical technique must be adapted to the open growth plates. Once the growth plates have closed in adolescents and teenagers, surgery can be performed using adult techniques. However, in this age group, an extremely high rate of recurrent injury must be expected (up to 30% ipsilateral re-ruptures or contralateral primary ruptures). The aim of this article is to present the current understanding of paediatric and adolescent ACL injuries, including challenges in their diagnosis and treatment with a particular focus on associated injuries.

There is broad consensus that Rockwood type II injuries are treated conservatively. However, several studies have shown that some of these patients have persistent mid- to long-term symptoms, partly due to horizontal instability.Patients with a side-to-side difference of up to 25% in the coracoclavicular distance on bilateral stress radiographs were included in this case series if they had either a posterior subluxation of the distal clavicle on axial radiographs and/or on MRI (in 8 patients), or if they showed dynamic posterior instability both clinically and radiologically. Injuries other than Rockwood type II or Rockwood type II injuries without horizontal instability were excluded.During the period from 2015 to 2022, 13 patients with an average age of 30.7 years (range 21-48 years) fulfilled the inclusion criteria. The mean time from trauma to final diagnosis was 32.4 days (range 7-67 days). Eight patients had an additional static posterior dislocation of the distal clavicle consistent with a Rockwood type IV injury. Five patients had dynamic posterior instability. All patients had initially been classified as having Rockwood type II injuries based on the findings of bilateral stress radiographs at the referring institution.The diagnosis of a Rockwood type II injury should not be based solely on bilateral stress radiographs but should instead be made only after horizontal instability has been ruled out with appropriate imaging modalities. Otherwise, Rockwood type IV injuries or Rockwood type II injuries with concomitant horizontal instability may be overlooked.

Back pain (BP) is a globally prevalent musculoskeletal disorder, affecting up to 85% of individuals at some point in their lives. It significantly affects quality of life and productivity, with a particularly high prevalence in athletes due to the high physical demands of their activity. This review examines the comparative effectiveness of conservative and surgical treatments for patients with disc herniation (DH), focusing on their return-to-sport (RTS) outcomes.A systematic review was conducted of studies evaluating RTS following conservative or surgical treatment of patients with DH. Databases including PubMed, MEDLINE, and EMBASE were searched for studies reporting RTS rates, recovery times, and long-term performance outcomes, with a focus on adult athletes.A total of 16 studies were included in this systematic review, consisting of retrospective and prospective cohort studies, randomised controlled trials, and case-control designs. These studies were specifically selected for their relevance to RTS outcomes following conservative or surgical treatment of intervertebral disc herniation in athletes. Collectively, the studies included approximately 2,500 athletes across various sports, such as football (NFL), soccer (Serie A), basketball (NBA), baseball (MLB), hockey (NHL), rugby, tennis, and rowing. Both conservative treatments (e.g., physical therapy) and surgical interventions (e.g., microdiscectomy) demonstrated high RTS rates, ranging from 78.9% to 97%. Athletes treated conservatively typically returned to play faster (4.7 months on average), whereas surgical treatment was associated with a slightly higher long-term RTS success (up to 97%) and recovery times ranging from 5.2 to 5.8 months. Notably, no significant long-term performance impairments were observed.Both treatment modalities were effective, with surgical approaches offering particular benefits for patients with neurological deficits or severe disc degeneration. Conservative treatment was associated with faster recovery, supporting its use as a first-line approach for patients with mild symptoms or athletes requiring rapid RTS.While both conservative and surgical treatments yield high RTS rates, the decision must be individualised based on the patient's symptom severity, neurological status, and sport-specific demands. Future studies should focus on optimising treatment protocols and developing standardised RTS criteria tailored to elite athletes for improved long-term functional outcomes.

Protein is one of the major supplements consumed among resistance training professionals, and its supplementation is associated with improved health and sports performance. However, dietary patterns, the use of supplements and their interrelationship have not been adequately investigated. The present study aims to assess the dietary habits and use of protein supplements among gym attendees in Punjab using a descriptive cross-sectional survey.For the study, a structured questionnaire was administered to 394 gym attendees using an interview-based approach, following informed consent. Frequency distributions were used to assess protein supplement use and demographic characteristics. The association between supplement use and dietary intake was analysed using the chi-square test in SPSS, with the level of significance set at 5%.Study findings indicated that overall protein supplement consumption was 40.6% among individuals in city centres and 22.9% in suburbs. Protein supplement use was higher among males than females. Non-users of supplements consumed more legumes than supplement users. The consumption of cheese, eggs, and fish was higher among supplement users compared to non-users. About one-third of the gym attendees also consumed unhealthy food items (bakery products and snacks).Overall, protein intake was higher among supplement users compared to non-users. The majority of gym attendees were unaware of basic nutrition knowledge and the principles of sports nutrition, and they followed the common misconception of a high-protein diet (from both food and supplements).

This study focuses on the application of functional movement screening (FMS) in the injury prediction and evaluation of table tennis players. In view of the sports injury risk faced by table tennis players in training and competition, this paper provides scientific injury risk assessment and personalized training suggestions for players through the FMS system.The FMS test is based on the basic movement pattern of the body, which evaluates the flexibility, stability, symmetry and overall movement quality of athletes to identify potential sports injury risks. Twelve table tennis players were selected and screened by the FMS test suite, including seven basic action tests and four exclusionary tests.Through the statistical analysis of the test results, it is found that table tennis players have common defects in specific action patterns, such as insufficient flexibility of shoulder joints and poor trunk stability.There is a significant correlation between FMS test scores and athletes' sports injury risk, which further verifies its important role in injury prevention. Based on the research results, this paper puts forward personalized training suggestions for table tennis players, aiming at reducing the risk of sports injury by improving the defects of action patterns.

This study aimed to investigate the electromyographic activity of the transversus abdominis (TrA) and erector spinae (ES) muscles in three different directions during the Y-Balance Test (YBT), and to assess the co-activation between these muscles. A total of twenty-four participants (mean age = 22.71 ± 1.48 years) were evaluated. Electromyographic data from the TrA and ES were recorded using surface electromyography (sEMG) during the YBT. The results revealed that the mean and maximum activity of the TrA in the anterior direction, with the dominant extremity on the ground, was significantly higher (p = 0.014). Additionally, the mean activity of the TrA (p = 0.030) and both the mean (p < 0.001) and maximum (p = 0.047) activity of the ES in the posteromedial direction, with the dominant extremity on the ground, were significantly elevated. The onset times of the TrA and ES contractions were correlated in posteromedial and posterolateral directions, irrespective of extremity dominance (p<0.05). Furthermore, correlations were observed between the mean TrA activity and the onset of ES (r = 0.447, p = 0.029), as well as between the mean ES value and the onset of TrA (r = 0.430, p = 0.036), in the posteromedial direction. This study concluded that TrA activation was most pronounced in the anterior direction with the dominant extremity on the ground, whereas the highest co-activation of the TrA and ES occurred in the posteromedial direction when the non-dominant extremity was on the ground.

In today's leisure society, sporting activities are becoming increasingly important for both younger and older people. Sport is generally considered to be healthy, but depending on the type of sport, intensity, gender, age and willingness to take risks, there is always a potential risk of injury in recreational and, above all, competitive/high performance sport, whereby high-impact and high-risk sports have contributed to an increase in the frequency of injuries, especially to the spine. However, when all sports injuries are taken together, winter sports in particular play the biggest role in sportsrelated spinal injuries, accounting for around 50%, which is why this article will focus on this in particular. While in competitive sports, the focus in many sports is always on maintaining performance after an injury and, particularly with regard to the financial consequences for professional athletes, on returning to sport as quickly as possible, in popular and everyday sports the focus is generally on the fullest possible convalescence regardless of time aspects and, for athletes who are still working, on maintaining their ability to work. However, there is little reliable data on rehabilitation after spinal injuries in Germany, if at all, primarily in competitive and high-performance sport, where systematic injury monitoring is carried out by the Verwaltungs-Berufsgenossenschaft for some types of sport. When and with what objectives rehabilitation after a spinal injury makes sense, especially in popular sports, is explained below.

This biomechanical study of 38 male and female recreational runners demonstrates the relationship between the four most frequently used footwear technologies and the biomechanical load on the lower extremities during running. Running with the four midsole technologies ((1) neutral, cushioning running shoes (N_LS), (2) supportive, motion control running shoes (S_LS), (3) maximalist, carbon-fibre plate running shoes (M_LS), and (4) running shoes with a U-shaped midsole construction and highly cushioning foam (U_LS)) indicates a strong impact of the midsole technology on the kinetics of the lower extremities. Midsole construction and material of the four running shoe categories systematically influence joint moments at the foot, ankle joint, and knee joint, thereby modulating the mechanical load on the biological structures of the lower extremities with each running step. The data demonstrate no significant differences in running kinetics between N_LS and S_LS, while M_LS increases and U_LS decreases ankle joint and knee joint load during the stance phase.A 12-month standardized and randomized intervention trial surveyed 1697 recreational runners who used one of the four dedicated running shoe categories in more than 75% of their runs. The results demonstrate a strong relation between the development of running-associated injuries in general, and knee and Achilles tendon problems in particular, and the footwear categories. While neutral and supportive running shoes show no significant differences in the development of running-related injuries, M_LS increases and U_LS decreases this risk, especially the occurrence of knee pain. Other risk factors, such as age, gender, BMI, running distance, average speed, surface as well as foot morphology and leg axis, only had a minor effect on the development of running-related injuries in the 12-month survey. Running shoe midsole technologies offer a sophisticated causal explanation for overload injuries of biological structures in the lower extremity during running and the resulting running-related injuries.

Returning to sport after anterior cruciate ligament reconstruction (ACLR) can be a challenging and complex process for the athlete, with the rate of return to the pre-injury level of sport observed to be less than athlete expectations. Of the athletes that do return to sport (RTS), knee re-injury rates remain high, and multiple studies have observed impaired athletic performance upon RTS after ACLR as well as reduced playing time, productivity, and career lengths. To mitigate re-injury and improve RTS outcomes, multiple RTS after ACLR consensus statements/clinical practice guidelines have recommended objective RTS testing criteria to be met prior to medical clearance for unrestricted sports participation. While the achievement of RTS testing criteria can improve RTS rates after ACLR, current criteria do not appear valid for predicting safe RTS. Therefore, there is a need to review the various factors related to the successful return to the pre-injury level of sport after ACLR, clarify the utility of objective performance testing and RTS criteria, further discuss safe RTS decision-making as well as present strategies to reduce the risk of ACL injury/re-injury upon RTS. This article provides a practical review of the current RTS after ACLR literature, as well as makes medical recommendations for rehabilitation and RTS decision-making after ACLR.

ACL rupture is a common injury in recreational and professional athletes. Most ACL tears occur in combination with an ALL lesion. Combined reconstruction of the ACL and ALL reduces re-rupture rates by up to 3.1 times compared to isolated ACL reconstruction using hamstring tendons; however, it has not yet been established as the surgical standard. The purpose of this study was to investigate if patients benefit from ACL+ALL reconstruction in terms of translation and rotation stability, return to activity and return to sport, as well as to assess any potential negative effects of this technique.This is a multicentric study of retrospectively collected patients who were followed up 12.7 months postoperatively. The patient sample consisted of 55 patients (group 1: n=29, Munich/Germany, ACL+ALL, femoral ALL fixation with interference screw, and group 2: n=26, Bolzano/Italy, ACL+ALL, femoral ALL-fixation with SwiveLock). Clinical outcomes were evaluated through instrumental measurements with two different devices to assess translational anteroposterior and rotational stability and through patient-reported outcome measures (Lysholm Score, Activity Rating Scale, Tegner Score, VAS (PROMs)).A total of 55 patients (mean (± SD) age: 24.7 ± 7.8 years) with a mean follow-up of 12.7 ± 1.5 months were included. The mean anterior translation of all operated (ACL+ALL) knees was 3.2 ± 1.1 mm and was not significantly different from the values of the non-operated knees (2.6 ± 1.0 mm). The results of the anterior drawer test in internal rotation were 3.3 ± 1.1 mm for the operated knee vs. 2.7 ± 1.0 mm for the non-operated knee (p=0.0014). There were no further significant differences between the operated and non-operated knee regarding translation or internal and external rotation. The mean value for pain on the lateral side of the knee was 1.1 ± 1.3 on the VAS 0-10 pain scale. All other PROMs showed no relevant differences between pre-injury and post-operative.ALL reconstruction restores the function of the anterolateral ligament of the knee. In this study, knee joint stability regarding anteroposterior translation and rotation showed values almost identical to those of the healthy non-operated contralateral knee. It leads to excellent patient outcomes with near pre-injury levels regarding the relevant PROMs. In particular, combined reconstruction did not result in any clinically significant negative side-effects such as pain on the ALL incision site or signs of overstrain in the lateral knee.

Adolescent elite athletes in Olympic sports often specialise at an early age, which increases the risk of overuse and traumatic injuries. The knowledge of injury patterns is a key aspect for prevention strategies. However, little is known about adolescent athlete's injury patterns in most Olympic sports. This study aimed to analyse the incidence and pattern of traumatic and overuse injuries in adolescent elite athletes from three Olympic sports with various physical demands.A retrospective data analysis was performed, including 348 initial orthopaedic consultations of adolescent elite athletes (m/f: 267/81, 15.9±1.7 years, 179±9 cm, 71±11 kg, 648±107 training hours/year). Athletes from handball (n=185), canoe sprint (n=112) and triathlon (n=51) presented at the local sports medicine centre. All consultations included a medical history obtained by a physician, an orthopaedic examination, and a documentation of anthropometric and training-related data. Injury patterns were classified for traumatic and overuse ratio, type, area, structure, and cause of injury. Incidence per 1000 hours (h) of exposure and injury ratio were analysed in the entire cohort and compared between sports.The mean injury incidence was 3.3/1000 h, while overuse injuries occurred approximately twice as often as traumatic injuries (2.0 versus 1.2/1000 h). Sport-specific total injury incidence was lowest in canoe sprint (1.6/1000 h) and highest in handball (4.7/1000 h). The traumatic versus overuse injury ratio was lowest in canoe sprint (0.13) and highest in handball (0.54). Injury incidence increased with age and training hours from 1.0/1000 h in young athletes (12-13 years) to 5.1/1000 h in older athletes (16-17 years). Type, area, structure and cause of injuries differed significantly between athletes of the three sports. Handball players presented with various traumatic and overuse pathologies, mostly located in the lower extremity. Canoeists and triathletes mainly suffered from tendon overload and muscle injuries of the extremities and the lower back.Both the total incidence and the ratio of traumatic versus overuse injuries differ between athletes participating in handball, canoe sprint, and triathlon. Overuse injuries occurred approximately twice as often as traumatic injuries in the present cohort. Further investigation is required to evaluate whether the variety of injuries seen in individual and team sports is to be taken into consideration in the development of prevention strategies.

To systematically compare the clinical efficacy of conservative treatment and arthroscopic one-stage repair for patients with first-time anterior dislocation of the shoulder. A retrieval and systematic review of randomized controlled studies of primary anterior shoulder dislocation with conservative versus arthroscopic repair was conducted and further pooled analysis was performed to compare the overall difference in clinical outcomes, including redislocation and revision surgery rates, shoulder function scores and related complications. Preliminary meta-analysis showed that the risk of anterior shoulder redislocation was 4.73-fold higher in patients treated conservatively than those undergoing arthroscopic repair (RR:4.73 [2.95-7.58], < 0.000; I = 0 %, = 0.920),and that the revision surgery rate was 5.91 times higher in the conservative group than in the arthroscopic repair group (RR:5.91 [2.82-12.39], < 0.000; I = 0 %, = 0.560).Early arthroscopic repair can significantly reduce the redislocation and revision surgery rates and also improve the shoulder joint function score, without serious complications. However, it is necessary to recognize the subset of patients with a higher risk of redislocation in young patients through a high quality, blinded, prospective cohort study when early arthroscopic repair intervention in this subset of high-risk patients will be of significant clinical value.

Injury burden is a composite measure of injury incidence and mean severity; this parameter has been reported as an output measure from injury surveillance studies in rugby for over 20 years. The benefits of reporting injury burden results have, more recently, been recognised in other sports. This wider use of injury burden as an output measure from injury surveillance studies has, however, highlighted misunderstandings about how to calculate, present and interpret injury burden data. The aim of this critical review is to explain why median severity and ordinal severity scales should not be used to calculate and report injury burden results in injury surveillance studies. Equations are presented to show how injury burden results should be calculated, and graphs and tables are presented to explain the errors that are introduced when median severity and ordinal scales of severity are used instead of mean severity. This critical review is intended to highlight the correct procedures for calculating, reporting and interpreting injury burden results in order to avoid incorrect results, conclusions and injury prevention recommendations being published.