Machine learning used to determine features of importance linked to overnight stay after patellar tendon repair.

Purpose: The purpose of this study is to determine if machine learning is an effective method to identify features of patients who may need a longer postoperative stay following a patellar tendon repair. Methods: The American College of Surgeons National Quality Improvement Program (ACS-NSQIP) was used to collect 1173 patients who underwent patellar tendon repair. Machine learning (ML) was then applied to determine features of importance in this patient population. Several algorithms were used: Random Forest, Artificial Neural Network, Gradient Boosting, and Support Vector Machine. These were then compared to the American Society of Anesthesiologists (ASA) classification system based logistic regression as a control. Results: Random Forest (RF) was determined to be the best performing algorithm, with an AUC of 0.72, accuracy of 77.66 %, and precision of 0.79, and recall of 0.96. All other algorithms performed similarly to the control. RF gave the highest permutation feature importance to age (PFI 0.25), BMI (PFI 0.19), ASA classification (PFI 0.14), hematocrit (PFI 0.12), and height (PFI 0.11). Conclusions: This study shows that machine learning can be used as a tool to identify features of importance for length of postoperative stay in patients undergoing patellar tendon repair. RF was found to be a better performing model than logistic regression at determining patients predisposed to longer length of stay as determined by AUC. This supported the study's hypothesis that ML can provide an effective method for identifying features of importance in patients requiring a longer postoperative stay after patellar tendon repair.

Effect of Forearm Supination and Pronation on Median & Ulnar Nerve Conduction Velocity Among Throwers, Archers, and Non-Athletes.

The distinct and specialized movements performed in different sports disciplines may significantly influence nerve performance, potentially affecting nerve responses and the overall function within the respective athletic activities. The purpose of this study is to find the effect of forearm supination and pronation across the elbow joint on ulnar and median nerve conduction velocity (NCV) in throwers, archers, and non-athletes. A total of 34 participants both male and females were recruited with a body mass index (BMI) between 18.5 and 24.9 kg/m2. Nerve conduction study (NeuroStim NS2 EMG/NCV/EP System) was used for measuring ulnar and median NCV across the elbow joint at different angles with the forearm in supination and pronation. Repeated measure analysis of variance (RMANOVA) revealed that there are statistically significant differences in mean values of forearm positions, angles, nerves and groups (p < .05). This study illuminates distinctive NCV variations across diverse athletic groups during forearm supination and pronation movements. Pronation consistently exhibited faster ulnar NCV compared to the median nerve across throwers, archers, and non-athletes, while in supination specific joint positions revealed notable differences within sports groups and nerve function.

Prediction of the Hamstring Graft Size for ACL Reconstruction Using Different Axial Layers in Preoperative MRI.

BACKGROUND: In ACL reconstruction, it is desirable to assess preoperatively whether a sufficient graft diameter can be achieved with the planned tendon graft. The present study investigated the effect of the location of the cross-sectional area (CSA) measurement of the hamstring tendons in preoperative MRI on the correlation of the CSA with the intraoperative graft diameter. In addition, we analyzed whether the measurement results of examiners with different skill levels were comparable. METHODS: A total of 32 subjects undergoing a single bundle ACL reconstruction using an autologous ipsilateral quadrupled hamstring graft (STGT) were included. The CSA of the semitendinosus and gracilis tendon was determined in preoperative MRI on six defined levels by three examiners. The intraclass correlation coefficient between the measurements of these observers was determined. The correlation between the sum of the CSA of both tendons (CSA STGT) and the graft diameter was investigated. RESULTS: The interrater reliability was excellent on most of the investigated levels. A significant correlation between CSA STGT and the graft diameter was seen on all levels. The strongest correlation was found on the level 10 mm above the joint line. CONCLUSIONS: The measurement of the CSA STGT in the preoperative MRI 10 mm above the joint line enabled a good assessment of the achievable graft diameter in ACL reconstruction, independent of the examiners' training level.

Traumatic Triceps and Medial Ulnar Collateral Ligament Rupture in an Adolescent Mogul Skier: A Case Report.

Triceps tendon ruptures are uncommon injuries that account for less than 1% of all upper extremity tendon injuries. Medial ulnar collateral ligament injury (mUCL), while common in overhead athletes as a result of valgus forces during the throwing mechanics, has scarcely been reported in non-overhead, throwing individuals. Traumatic assault to the elbow may result in the rupture of the triceps tendon with concomitant mUCL injury. As such an injury pattern typically presents in middle-aged males, weightlifters, or American football players from eccentric overloading of the elbow. We present an adolescent, elite-level, competitive skier with traumatic onset distal triceps rupture with concomitant medial ulnar collateral ligament rupture suffered via a fall on an outstretched hand (FOOSH) mechanism. Magnetic resonance imaging (MRI) showed acute full-thickness avulsion of the distal triceps tendon occurring at the olecranon enthesis. An open tendon repair was performed, and the patient was able to report significant symptom resolution over the course of six months postoperatively and successfully return to elite-level competition. This was a unique and rare case of triceps tendon rupture with concomitant mUCL injury in an adolescent via a non-contact, high-velocity injury mechanism. While a rare injury combination, this case nevertheless identifies an area of research not currently extensively covered-trampoline training and associated injuries in adolescents. This case, therefore, not only adds a novel dimension to the understanding of triceps and mUCL injuries in young athletes but also underscores the need for heightened awareness and specific safety protocols in sports training involving equipment like trampolines.

Nonsurgical Rehabilitation Perspectives for a Type I Salter-Harris Fracture With Lipohemarthrosis and Concomitant Grade II Anterior Cruciate Ligament (ACL) Tear in a Volleyball Athlete: A Case Report.

Anterior cruciate ligament (ACL) tears represent common occurrences in sports, particularly posing significant risks to young athletes. The diagnostic methods for ACL injury include magnetic resonance imaging (MRI), arthroscopy, and physical examination. Management of this injury can be done both operative and nonoperatively. Pediatric growth plate fractures are classified under the Salter-Harris classification. A 13-year-old male athlete sustained a knee injury during a volleyball match. While landing from a jump after a smash, the athlete directly landed on the ground on his right knee. After this, he reported discomfort and severe anterior knee pain. Due to immobility and pain, he was taken to the emergency unit. Upon radiographic examination, a Salter-Harris Classification Type I fracture was found, indicating epiphyseal slip and separation through the physis of the right proximal tibia medially. An MRI imaging was done to check the integrity of the ACL after the swelling had subsided post-15 days of injury. An MRI identified a bony contusion on the medial tibial plateau, extending to the physeal plate with a Grade II ACL tear. The concurrent occurrence of ACL injury and growth plate injury presents a significant concern. Hence, a referral for physical therapy rehabilitation was given. Our findings highlight the importance of prompt initiation of physical rehabilitation following such injuries. Where non-surgical rehabilitation strategies play a crucial role in managing these cases while focusing on restoring knee stability, promoting healing of the growth plate, and facilitating a safe return to sport. Tailored rehabilitation, including therapeutic exercises, neuromuscular training, and proprioceptive training, is essential for optimizing outcomes and preventing long-term complications. The case underscores the importance of a multidisciplinary approach in managing the complex knee injury of this young athlete.

Wrist Motion Assessment in Tennis Players using Three-Dimensional Motion Capture and Dynamic Electromyography.

Background Tennis players often present with ulnar-sided wrist pain, which may reflect repetitive stress and/or faulty mechanics. There is a role for investigating the biomechanics of tennis strokes and how they may relate to wrist pathology. The purpose of this study was to investigate whether three-dimensional motion capture technology and dynamic electromyography (EMG), when used to study groundstrokes in elite junior tennis players, reveals patterns of upper extremity motion that may correlate with the development of clinically relevant pathology. Case Description Three-dimensional kinematic and EMG data were collected from two United States Tennis Association-ranked adolescent tennis players during groundstrokes. There were several observed differences in the two players' degree and timing of pronation/supination, ulnar/radial deviation, and flexion/extension during their strokes. Clinical Significance Advanced motion capture technology facilitates a nuanced understanding of complex movements involved in groundstroke production. This methodology may be useful for identifying athletes who are at risk for injury and guiding rehabilitation for players experiencing pain. Level of Evidence IV.

[Muscle injuries: the importance of high-resolution dynamic sonography in diagnostics, treatment and monitoring]. / Muskelverletzungen: Stellenwert der hochauflösenden dynamischen Sonographie in der Diagnostik, Therapie und im Monitoring.

BACKGROUND: Muscle injuries are common in football. Imaging diagnostics have a major role in establishing a diagnosis. The main diagnostic procedures are MRI and ultrasound. Both diagnostics have advantages and disadvantages, which should be balanced against each other. NEW ULTRASONIC TECHNIQUES: The role of MRI as the gold standard is increasingly being replaced by high-resolution ultrasound techniques, and MRI imaging is not always useful. To detect complications in the early stages it is advised to perform regular ultrasound-imaging check-ups. The healing process can be monitored, and it offers additional options for ultrasound-guided interventions such as hematoma punctures and targeted infiltrations. ADVANTAGES AND DISADVANTAGES: However, ultrasound imaging is highly user dependent. Experienced operators can eliminate this disadvantage, which makes ultrasound a superior imaging system in many areas, especially for dynamic examinations. Nevertheless, MRI imaging remains a necessary imaging method in certain areas.

Gender Differences in Achilles Tendon Ruptures-A Retrospective Study and a Review of the Literature.

Achilles tendon ruptures are common injuries typically sustained during sport with higher incidence in men, though little is understood regarding sex-specific risk factors or outcomes following injury management. This cross-sectional clinical study and systematic review aimed to examine sex-specific Achilles tendon rupture incidence and outcomes following intervention. This study included patients who sustained a rupture between 2011-2021, were ≥18 years old, and who had a minimum follow-up of at least six months, and evaluated age, sex, sport involvement, mechanism of injury, and postoperative complications and revision. Separately, a systematic literature review in the PubMed, EMBASE, and Cochrane databases was performed. A total of 705 male and 158 female patients were included in this retrospective study. 71.1% of men and 52.5% of women sustained a sports-related rupture (p < .001), with sport involvement demonstrating a positive correlation with revision rate (coefficient = 0.09, p = .02). A total of 21 studies with 250,907 patients (87,514 male, 35,792 female) were included in the systematic review. All studies revealed an increased incidence of ATR in men. Functional outcomes were worse in women, and female sex was an independent risk factor for postoperative complications and need for revision surgery. This study demonstrated a higher incidence of sports-related ATR in men than women, likely related to their higher ball sport participation. Although the retrospective analysis did not find a significant difference in complication or revision rates, the systematic review demonstrates poorer functional outcomes, with increased likelihood for postoperative complication and revision surgery in women as compared to men.

Assessing Lower-Extremity Visuo-Motor Reaction Time in Young Male Soccer Players: Test-Retest Reliability and Minimum Detectable Change of the Brain Pro System.

A reliable, versatile means of assessing visuo-motor reaction time (V-MRT) is important to football (soccer) players for many reasons, including the fact that faster V-MRT is a critical sport skill that may even play a role in reducing common sports injuries to the lower muscle extremities that can be associated with lost time on the field. We aimed to determine the test-retest reliability and minimum detectable change (MDC) of the Brain Pro System for assessing lower-extremity V-MRT in young male football players. We had 68 participants (M age = 16.35, SD = 1.71 years) perform two assessment sessions one-week apart. For test-retest reliability, we calculated a one-way intra-class correlation coefficient (ICC) at the 95% confidence interval and provided the standard error of measurement (SEM) and minimum detectable change (MDC) (MDC = SEM × 1.96 × âˆš2) for V-MRTs. We obtained excellent V-MRT test-retest reliability for dominant lower-extremity, non-dominant lower-extremity, and dominant and non-dominant lower-extremities (ICC2,1 = .93, 95%CI = .89-.96; ICC2,1 = .94, 95%CI = .91-.96; ICC2,1 = .96, 95%CI = .94-.97; respectively). The calculated MDC for the dominant lower-extremity V-MRT, the non-dominant lower-extremity V-MRT, and dominant and non-dominant lower-extremities (random) V-MRT were 1.21 seconds, 1.13 seconds, and 1.21 seconds, respectively. Brain Pro System had excellent reliability for assessing lower-extremity V-MRT in young male football players. The MDC values at the 95% confidence level (MDC95) we obtained were reliable for assessing clinically meaningful V-MRT changes.

The Effects of Lower Leg Compression Garments on Lower Extremity Sports Injuries, Subjective Fatigue and Biomechanical Variables: A Systematic Review with Meta-analysis.

The objective of this study was to systematically review the literature on the effect of CGs versus non-CGs (such as regular socks) or versus placebo garments on 1) the incidence of lower extremity sports injuries and 2) subjective ratings of fatigue and biomechanical variables in athletes at participating in any sport that required any level of running performance, given that fatigue-related biomechanical alterations may increase the risk of sports injuries. This study was a systematic review with meta-analyses. PubMed, Embase, CINAHL, Cochrane, PEDro, and Scopus were searched for eligible studies until 7 July 2021. Two reviewers independently assessed the risk of bias using the Cochrane Collaboration's tool for risk of bias. Meta-analyses were performed using a random-effects model. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence for all outcome measures. Twenty-three studies, all with a high risk of bias, were included. Nineteen studies were used in the meta-analyses. No studies focused on the effect of CGs on the incidence of lower extremity sports injuries in athletes. Seventeen studies investigated the effect of CGs on subjective ratings of fatigue, but meta-analysis showed no difference in effectiveness between CGs versus non-CGs (such as regular socks) and versus placebo CGs (low certainty evidence). Because of heterogeneity, pooling of the results was not possible for the biomechanical variables. Nonetheless, low certainty evidence showed no effect of CGs. We identified no evidence for a beneficial or detrimental effect of lower leg CGs on the occurrence of lower extremity sports injuries, subjective ratings of fatigue, or biomechanical variables in athletes at any level of running performance. Based on the variable use of running tests, definitions used for biomechanical variables, and reporting of CG characteristics and more standardized reporting is recommended for future studies evaluating CGs.

An in-depth analysis of wound incidence and injury status among professional athletes: A comprehensive review.

This review aims to synthesize current knowledge on the incidence, characteristics and management of wounds and injuries among professional ice hockey athletes, with the specific focus on the emerging population of Chinese female players. An extensive literature search was conducted across several databases to gather data on injury patterns and wounds, causes, severity and prevention strategies in ice hockey. Special attention was given to studies involving female athletes and unique challenges faced by players in developing regions like China. The review also examined the impact of training modalities, protective equipment and medical interventions on injury rates. The findings reveal a significant seasonal fluctuation in wound incidence, with marked reduction following the preseason period. This trend underscores the effectiveness of adjusted training programmes and essential role of medical teams in injury prevention and rehabilitation. Analysis did not show significant difference in wound rates between technical and physical training sessions, suggesting that injuries are pervasive risk across all training activities. Skating, collisions and inadequate warm-ups were identified as the leading causes of wounds, highlighting areas for targeted preventive measures. The distribution of wounds across various body regions pointed to knee, lower back and wrist as the most vulnerable sites, necessitating focused protection and training adjustments. Ice hockey, particularly among female athletes in China, presents complex injury landscape characterized by the wide range of wounds. The study emphasizes the necessity of comprehensive, multidisciplinary approach to injury prevention that includes training modifications, enhanced protective gear and strategic medical oversight. By addressing the specific causes and patterns of injuries identified, stakeholders can better protect athletes from the inherent risks of the sport, promote safer play and extend career longevity.

A Case Report on Medial Patellofemoral Ligament Reconstruction Rehabilitation in a Cricket Player Through Targeted Agility Training.

The medial patellofemoral ligament (MPFL) serves as a crucial stabilizer, preventing lateral dislocation of the patella. Surgery is usually advised after a second dislocation, with MPFL reconstruction being a common procedure. The primary objective of rehabilitation post-surgery is not just to relieve pain and restore range of motion (ROM), but also to combine proprioceptive neuromuscular training to help patients return to their prior functional level. Agility training is a crucial component in accomplishing this goal. The current case is of a 19-year-old male cricket player with a history of recurrent patellar dislocation who underwent surgery after the latest incident rendered him unable to bear weight. His rehabilitation program included standard protocols alongside the early implementation of agility drills, such as ladder exercises. Compared to traditional approaches, this case demonstrates significant improvement in the patient's functional ability following surgery. This report highlights the importance of comprehensive rehabilitation for patients undergoing MPFL reconstruction. It not only underscores the rationale behind the surgery but also lays the groundwork for comparing recovery times. Notably, this program incorporated early agility exercises from the very beginning, suggesting that such an approach might accelerate recovery compared to standard protocols. Further investigation is warranted to explore the potential benefits of early agility training in this patient population.

Injuries and illness of athletes at the Tokyo 2020 Olympic and Paralympic summer games visiting outside facilities.

This study aimed to identify the reasons for transferring athletes to local medical facilities during the Olympic and Paralympic Games. Data on 567 injuries and other illnesses of athletes treated at the on-site clinics were collected from the Tokyo 2020 Organizing Committee. Of these, 84 athletes who required outpatient care during the Games were registered for this survey. During the Olympic and Paralympic Games, 66 (8.3/1 000) and 18 (7.2/1 000) athletes, respectively, consulted external medical facilities. In the Olympic Games, the reasons for these visits included 48 cases (72.7%) of injuries, 13 (19.7%) cases of illnesses, and 5 (7.6%) cases of heat stroke illness (HSI). Of these patients, 56 (84.9%) were treated as outpatients and 10 (15.1%) were hospitalized, while three of these patients required hospitalization for > 7 days. On the other hand, in the Paralympics Games, there were 7 (38.8%) cases of injuries, 9 (50.0%) other illnesses, 1 (5.6%) case of HSI, and 1 (5.6%) other cases, of which 11 (61.1%) were treated as outpatients and 7 (38.9%) were hospitalized, but none was hospitalized for > 7 days. Injuries accounted for 70% of the total cases at the 2021 Olympic Games, but only three (0.05%) were severe cases that required hospitalization for more than 1 week. In contrast, in the Paralympic Games, other illnesses accounted for approximately half of the total cases. This study provides details on the extent of injuries and other illnesses that were transferred to outside facilities, which has not been documented in previous games.

Tibialis Anterior Tendon Reconstruction Utilizing Split Tendon Turn-down: A Case Report and Technique Guide.

Tibialis anterior tendon (TAT) ruptures are rare, equating to less than 1% of all musculotendinous injuries. These injuries can be acute or atraumatic, with the latter often associated with chronic degenerative tendinopathy. Surgical repair is indicated when conservative measures fail in meeting functional demands. Direct end-to-end repair is the preferred method for TAT ruptures but may not be feasible with a large tendon defect. Various surgical techniques have been described to address this pathology, including allograft tendon interposition or extensor hallucis longus (EHL) transfer. The authors present a unique technique utilizing a minimal incision TAT turn-down with dermal matrix allograft augmentation, and, in addition, a case implementing this technique in a patient with a large insertional defect. The patient's postoperative course and outcomes were favorable, with improvements in pain, satisfaction, functional scores, and strength. The surgical technique offers versatility and can be adapted to different tendon defect sizes. It also allows for minimal-incision exposure, beneficial for patients with comorbidities or compromised skin integrity. In conclusion, the authors present a case report and surgical technique for the management of large-deficit, chronic TAT ruptures using split TAT turn-down. This technique provides a potential solution for cases where direct end-to-end repair is not feasible.Level of Evidence: Level V.

Prospective study of maturation and injury in elite handball academy. Could ‘maturational status’ be a risk factor for injury incidence in different handball team categories?

The objective of this study is to describe the relationship between injury incidence (IL) and maturity in male elite handball's player (HbP). Prospective study during two seasons, evaluating the sports injuries, maturity status and exposure time in hours in 133 young handball's players, under the UEFA methodology model for epidemiological studies. We discuss the maturity stage with different parameters, the Tanner's stage, puberty stages, peak high velocity, testicular volume, and the bone age. Finally, 190 injuries for a total of 34.222 h of exposure were registered. The average total Injury Incidence (IIn) by categories was 5,6 injury/1000 h of exposure. Injury Incidence during competition: 21,8 injuries/1000 hs and in training: 3,1 injuries/1000 hs without statistically significant between IIn, chronological age and different maturity stage by ANOVA. The multivariate statistical analysis registers tendency associations between IIn in competition for category (P = 0,07), and the IIn in training for Tanner stage (P = 0,091) and puberty (P = 0,021). In conclusion: there is not a significant difference in total IIn by ages categories in handball players but there is statistically significance tendency respect to some maturity parameters under a multivariate analysis. This last result must be considered when planning training seasons and strategies for injury prevention in the context of the formative handball. (AU)

Popliteal Artery-Related Pathologies in Athletes-A Primer for Musculoskeletal Radiologists.

Vascular complications in athletes are common and mimic musculoskeletal injuries such as muscle sprains, fractures, and cartilage abnormalities. They include traumatic vascular injuries and more subtle pathologies like entrapment syndromes, pseudoaneurysms, arterial occlusions, and venous thrombosis. Such vascular complications may be occult on imaging and can be difficult for a musculoskeletal radiologist to diagnose, resulting in a lack of timely diagnosis and potentially limb-threatening consequences. Although the final diagnosis may require multidisciplinary input from orthopaedic, sports and exercise medicine, and vascular and interventional radiology inputs, a musculoskeletal radiologist with prior knowledge of such conditions can be the first to diagnose such conditions aiding the athlete's performance. A musculoskeletal radiologist should pay due attention to anatomical courses of vascular channels and look for potential causes of vascular compression, aberrant myotendinous bands, accessory muscles, etc., before concluding a computed tomography (CT) or magnetic resonance imaging (MRI) as normal. Doppler ultrasound, CT, or MR angiography are commonly employed techniques for primary evaluation, whereas digital subtraction angiography is generally reserved for troubleshooting as advanced dynamic imaging.

Groin injuries in women's premier league football in Norway: A two-season prospective cohort study describing clinical and imaging characteristics.

OBJECTIVE: To describe the prevalence, incidence, and burden of groin injuries in the Norwegian women's premier football league and to describe their clinical and imaging characteristics. METHODS: During the 2020 and 2021 seasons, players in the Norwegian women's premier league reported groin injuries weekly, using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems (OSTRC-H2). We calculated weekly prevalence, incidence, and burden of groin injuries. The team physical therapists classified the player-reported injuries based on the Doha classification system. Injuries with more than 3 days' time loss or reported in 2 consecutive weeks were eligible for magnetic resonance imaging (MRI). RESULTS: On average, 3.9% (95% CI: 3.4-4.4) of players reported a groin injury at any time; of which 78% caused time loss. The incidence rate was 1.6 injuries/1000 h (95% CI: 1.3-2.0) and their burden was 11 days lost/1000 h. The physical therapists examined 67 of 124 player-reported groin injuries (53%). Adductor-related injury was most common (55%) followed by iliopsoas (15%) and rectus femoris-related (12%). Pubic-related injuries caused most time loss (median: 24 days, IQR: 5-133). In this study, 42 injuries were investigated with MRI; 8 (19%) showed no changes, 6 (14%) an acute musculotendinous lesion, and 32 (76%) a nonacute finding (e.g., central symphyseal disc protrusion, tendinopathies). CONCLUSION: The incidence rate and burden of groin injuries were high. Adductor-related injuries were most common, but pubic-related injuries caused most time loss. Most MRI examinations demonstrated nonacute findings.

Injury prevalence and associated factors among Japanese lacrosse collegiate athletes.

Context: Sports injuries have a substantial impact on athletes' performance and health. To reduce the risk of an injury occurring, the prevalence, localization, and severity need to be established. Objective: To examine the prevalence of sports injuries in collegiate lacrosse athletes. Design: Descriptive epidemiological study using online survey design. Setting: Japanese universities associated with UNIVAS. Participants: A total of 1,689 Japanese collegiate lacrosse athletes, 978 females and 701 males. Main outcome measures: Athletes were surveyed on the injuries within the previous year, their severity, localization, and onset characteristics. The support of an athletic trainer and its association with the odds of sustaining an injury was assessed. Factors related to injuries were explored. Results: One-year prevalence of injuries was 42%. Male sex, higher year at the university, and support from an athletic trainer were identified as factors related to higher odds of sustaining an injury and practicing at least 5 days per week was associated with lower odds of sustaining an injury. Conclusions: Male sex athletes, and athletes at the higher year at university are especially at risk of sustaining a lacrosse injury. The aspects of training (e.g., frequency, volume) should be investigated across the athlete development process to address these findings. Further investigation is needed to determine the extent to which the support of athletic trainers affects both the frequency and severity of injuries in lacrosse athletes.

Distal rupture of the biceps brachii tendon in a female mixed martial arts athlete: a case report.

The distal rupture of the biceps brachii muscle tendon (DBT) accounts for 3% of biceps ruptures. Diagnosis typically relies on high clinical suspicion and complementary imaging studies, with >90% of cases documented in males between the fourth and sixth decades of life. Reports of DBT ruptures in females are scarce, mostly involving partial and degenerative injuries. Here, we present an unprecedented case of a 28-year-old female professional mixed martial arts athlete with a total traumatic DBT rupture. The athlete underwent surgical repair using anchor reattachment technique. No complications were observed, and the athlete showed satisfactory outcomes, being cleared for physiotherapy after 2 weeks and returning to sports after a 3-month postoperative period.

Surgical treatment of distal hamstring tendon injuries yield a higher return-to-sports rate: A systematic review.

PURPOSE: The purpose of this study is to compare the patient-reported outcomes and return to sports of the conservative and surgical treatment of distal hamstring tendon injuries. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, two reviewers searched PubMed, Scopus and Virtual Health Library databases in January 2023. Clinical studies evaluating conservative or surgical management outcomes of distal hamstring tendon injuries were considered eligible for this systematic review if predefined criteria were fulfilled: (1) published in English or Spanish; (2) evaluated any of the following: patient-reported outcomes, return-to-sports rate (RTS-R) or return-to-sports time (RTS-T). Data were presented in tables using absolute values from individual studies and derived pooled percentages. RESULTS: Eighteen studies were included for 67 patients and 68 distal hamstring tendon injuries. Initially, 39 patients (58.2%) underwent surgical treatment, whereas 28 (41.8%) were treated conservatively. Among conservative treatment patients, 15 failed and had to be operated on (53.6%), all with distal semitendinosus tendon injuries. Anchor fixation was the technique of choice in 20 lesions (36.4%), tenodesis in 16 (29.1%), tenectomy in 14 (25.5%) and sutures were preferred in five (9%). Thirteen out of 28 patients (46.4%) undergoing initial conservative treatment returned to sports at a mean of 3.6 months (range 1 week to 12 months), in contrast to surgical treatment, in which 36 out of 39 patients (92.3%) returned at a mean of 4.2 months (range 6 weeks to 12 months). Additionally, 14 of 15 patients (93.3%) converted to surgical treatment after failed conservative treatment returned to sports at a mean of 7.6 months after injury. CONCLUSION: Initial surgical treatment of distal hamstring tendon injuries yields a high RTS-R (92.3%) at a mean of 4.2 months. Furthermore, 15 out of 28 patients (53.6%) initially treated conservatively had to be operated on, delaying the RTS-T (mean 7.6 months after injury) without affecting their RTS-R. LEVEL OF EVIDENCE: IV.