Blood flow restriction (BFR) training involves low-weight exercises performed under vascular occlusion via an inflatable cuff. For patients who cannot tolerate high-load exercises, BFR training reportedly provides the benefits of high-load regimens, with the advantage of less tissue and joint stress. Low-load BFR training is safe and efficacious for strengthening muscle groups proximal, distal, and contralateral to tourniquet placement in the lower extremities. Randomized controlled trial. Level 1. This was a randomized controlled trial of healthy participants completing a standardized 6-week course of BFR training. Patients were randomized to BFR training on 1 extremity or to a control group. Patients were excluded for cardiac, pulmonary, or hematologic disease; pregnancy; or previous surgery in the extremity. Data collected at baseline and completion included limb circumferences and strength testing. The protocol was completed by 26 patients, providing 16 BFR and 10 control patients (mean patient age, 27 years; 62% female). A statistically greater increase in strength was seen proximal and distal to the BFR tourniquet when compared with both the nontourniquet extremity and the control group (P < 0.05). Approximately twice the improvement was seen in the BFR group compared with controls. Isokinetic testing showed greater increases in knee extension peak torque (3% vs 11%), total work (6% vs 15%), and average power (4% vs 12%) for the BFR group (P < 0.04). Limb circumference significantly increased in both the thigh (0.8% vs 3.5%) and the leg (0.4% vs 2.8%) compared with the control group (P < 0.01). Additionally, a significant increase occurred in thigh girth (0.8% vs 2.3%) and knee extension strength (3% vs 8%) in the nontourniquet BFR extremity compared with the control group (P < 0.05). There were no reported adverse events. Low-load BFR training led to a greater increase in muscle strength and limb circumference. BFR training had similar strengthening effects on both proximal and distal muscle groups. Gains in the contralateral extremity may corroborate a systemic or crossover effect. BFR training strengthens muscle groups proximal, distal, and contralateral to cuff placement. Patients undergoing therapy for various orthopaedic conditions may benefit from low-load BFR training with the advantage of less tissue stress.

Proximal hamstring avulsions cause considerable morbidity. Operative repair results in improved pain, function, and patient satisfaction; however, outcomes remain variable. To evaluate the predictors of clinical outcomes after proximal hamstring repair. Case series; Level of evidence, 4. We retrospectively reviewed proximal hamstring avulsions repaired between January 2014 and June 2017 with at least 1-year follow-up. Independent variables included patient demographics, medical comorbidities, tear characteristics, and repair technique. Primary outcome measures were the Single Assessment Numerical Evaluation (SANE), International Hip Outcome Tool–12 (iHOT-12), and Kerlan-Jobe Orthopaedic Clinic (KJOC) Athletic Hip score. Secondary outcome measures included satisfaction, visual analog scale for pain, Tegner score, and timing of return to sports. Of 102 proximal hamstring repairs, 86 were eligible, 58 were enrolled and analyzed (67%), and patient-reported outcomes were available for 45 (52%), with a mean 29-month follow-up. The mean patient age was 51 years, and 57% were female. Acute tears accounted for 66%; 78% were complete avulsions. Open repair was performed on 90%. Overall satisfaction was 94%, although runners were less satisfied compared with other athletes (P = .029). A majority of patients (88%) returned to sports by 7.6 months, on average, with 72% returning at the same level. Runners returned at 6.3 months, on average, but to the same level 50% of the time and at a decreased number of miles per week compared to nonrunners (15.7 vs 7.8, respectively; P < .001). Postoperatively, 78% had good/excellent SANE Activity scores, but the mean Tegner score decreased (from 5.5 to 5.1). Acute tears had higher SANE Activity scores. The mean iHOT-12 and KJOC scores were 99 and 77, respectively. Endoscopic repairs had equivalent outcome scores to open repairs, although conclusions were limited given the small number of patients in the endoscopic group. Greater satisfaction was noted in patients older than 50 years (P = .024), although they were less likely to return to running (P = .010). Overall, patient satisfaction and functionality were high. With the numbers available, we were unable to detect any significant differences in functional outcome scores based on patient age, sex, body mass index, smoking status, medical comorbidities, tear grade, activity level, or open versus endoscopic technique. Acute tears had better SANE Activity scores. Runners should be cautioned that they may be unable to return to the same preinjury activity level after proximal hamstring repair. When counseling patients with proximal hamstring tears, runners and those with chronic tears should set appropriate expectations.

Background: Pickleball is currently the fastest-growing sport in the United States, and participation has increased 3-fold throughout the study period. Purpose/Hypothesis: This study aimed to evaluate the epidemiology of pickleball-related injuries, detailing the descriptive data, injury patterns, and health care utilization at a single center over 6 years. It was hypothesized that there would be a substantial increase in pickleball-related injuries during the study period, particularly with increasing age, along with increased orthopaedic visits for pickleball-related injuries. Study Design: Case series; Level of evidence, 4. Methods: We systematically queried the Electronic Health Record System at a single institution from January 1, 2017, to December 31, 2022, to identify patients with injuries associated with pickleball participation. Data were collected on descriptive data, injury characteristics, and health care utilization. Results: Pickleball injuries were confirmed in 487 patients, accounting for a total of 618 injuries. Patient age ranged from 12 to 82 years (mean, 62 years), and 53% of injuries occurred in male patients. The number of injuries increased 6.8-fold from 2017 to 2022. Overall, soft tissue strain or rupture (n = 296; 47.9%) was the most common injury category, followed by arthritis-related pain (n = 62; 10%) and fracture (n = 57; 9.2%). However, age-stratified analysis revealed a shift toward fractures and arthritis-related pain in patients >60 years. Women were 2 times more likely to sustain fractures. Injuries to the rotator cuff were most commonly seen (n = 67, 11%), followed by those to the back (n = 48; 7.8%) and calf (n = 35; 5.6%). Most patients (n = 426; 87%) were initially evaluated by a nonorthopaedic provider, with orthopaedic/sports medicine providers seeing 63% of patients. Conclusion: Our institution observed a 6.8-fold increase in pickleball-related injuries from 2017 to 2022, which far outpaces the reported increase in pickleball participation nationally. Women >60 years were found to be at the highest risk of injury and were more likely to sustain fractures. Most injuries were musculoskeletal related, with soft tissue injury occurring most commonly in patients 60 years.