Purpose: To compare complications, unplanned reoperations, and costs between single‐stage and 2‐stage treatment of multi‐ligament knee injuries. Methods: The MarketScan database was queried (2007‐2016), identifying patients undergoing surgery for a multi‐ligament knee injury. The single‐stage cohort was defined as having at least 2 Current Procedural Terminology codes for ligament reconstruction at the index procedure without a Current Procedural Terminology code for ligament reconstruction appearing in the database for the following 12 months. The 2‐stage cohort was defined as undergoing multiple ligament reconstruction procedures within a 12‐month period with subsequent ligament procedure codes that differed from the index ligament reconstruction codes. Propensity score matching was performed using a greedy nearest‐neighbor algorithm to match specific injury patterns between the 2 cohorts. Baseline demographic characteristics, medical comorbidities, and the Charlson Comorbidity Index were recorded. Complications, unplanned reoperations, and total health care expenditures were recorded for up to 5‐year follow‐up. Two‐sample t tests, χ ² tests, and Fisher exact tests were used with an α level of .05 set as significant. Results: We identified 1,150 patients who underwent surgery for multi‐ligament knee injuries (1,080 with single‐stage approach and 270 with 2‐stage approach). No significant differences in baseline characteristics or medical comorbidities were found between the cohorts. After propensity score matching, the single‐stage group had fewer complications at 30, 90, 180, and 365 days ( P < .05). Two‐stage treatment increased the risk of reoperation at 1 year (5.5 times) and 2 years (4.9 times) after the index procedure. Health care expenditures were lower in the first 9 months for the staged cohort, but from 9 months ($31,210 vs $22,252, P < .0001) through 5 years, total costs were higher in this group. Conclusions: Single‐stage surgical treatment of multi‐ligament knee injuries results in fewer complications and reoperations and lower total costs compared with 2‐stage treatment, even after controlling for the number and combination of ligaments injured. Level of Evidence: Level III, retrospective cohort study.

Background: Flexible ligamentous fixation has increased in popularity for the treatment of ligamentous Lisfranc injury, but the optimal fixation strategy is unclear. Purpose: To review the biomechanical, clinical, and radiographic results of ligamentous Lisfranc injuries treated with flexible fixation. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed/Medline and Google Scholar literature databases were queried for clinical and biomechanical (cadaveric) studies relating to flexible fixation of ligamentous Lisfranc injury. Outcomes of interest included patient-reported outcome scores, clinical/biomechanical results, radiographic alignment, and return to activity. Where appropriate, meta-analysis of the postoperative outcomes was performed. Results: Of the 34 initial studies, 14 articles (243 feet) were included in the analysis. In the 11 clinical studies (216 patients), the mean postoperative American Orthopaedic Foot & Ankle Society score was 90.1 (n = 150; 6 studies) and the mean visual analog scale score was 1.5 (n = 137; 5 studies). The rate of return to activity was 100% (n = 35; 5 studies), and 100% of patients maintained radiographic alignment postoperatively (n = 62; 6 studies). No complications or subsequent hardware removals were reported. Of the 3 biomechanical studies (27 feet), 1 study found significantly greater change in diastasis under axial load between intact and postfixation ligaments with suture button versus screw fixation (+1.1 vs –0.1 mm; P < .05), another found no difference in the decrease in diastasis under axial load between the injured state and screw or suture button fixation (1.2 vs 1.0 mm; P = .5), and the third found no difference in displacement between intact and either screw or suture button fixation under either axial (intact vs screw: 1.0 vs 2.0 mm, P = .1; intact vs suture button: 0.6 vs 1.8 mm, P = .1) or abduction (intact vs screw: 1.5 vs 1.1 mm, P = .5; intact vs suture button: 1.3 vs 2.1 mm, P = .1) load. Conclusion: Flexible fixation use in the treatment of ligamentous Lisfranc injury was found to have significant potential as a fixation option, as demonstrated by excellent clinical results. Biomechanical evidence was inconclusive but suggested a trend toward decreased diastasis in specimens fixed with screws compared with suture buttons.

To report the injury prevention programs utilized by top-level female footballers competing internationally. An online survey was administered to physicians of the 24 competing national teams at the 2019 FIFA Women's World Cup. The survey included 4 sections regarding perceptions and practices concerning non-contact injuries: (1) risk factors, (2) screening tests and monitoring tools, (3) preventative strategies and (4) reflection on their World Cup experience. Following responses from 54% of teams, the most common injuries encountered included muscle strains, ankle sprains, and ACL ruptures. The study also revealed the most important injury risk factors during the FIFA 2019 World Cup. Intrinsic risk factors include accumulated fatigue, previous injury, and strength endurance. Extrinsic risk factors include reduced recovery time between matches, congested match schedule, and number of club team matches played. The 5 most used tests for risk factors were flexibility, joint mobility, fitness, balance, and strength. Monitoring tools commonly used were subjective wellness, heart rate, minutes/matches played, and daily medical screening. Specific strategies to limit risk of ACL injury included the FIFA 11+ program and proprioception training. The present study revealed multifactorial approaches to injury prevention strategies for women's national football teams at the FIFA 2019 World Cup. Challenges to injury prevention program implementation reflect time limitations, schedule uncertainties, and varying club team recommendations. IV.

Background: Early sport specialization, involving intensive focus on a single sport for greater than 8 months per year at a prepubescent age, has become increasingly common in young athletes. While early sport specialization is often regarded as essential for success, there is growing concern that the potential risks to young athletes may outweigh the perceived benefits. Although numerous studies have explored early sport specialization, there has been no summative review on the topic in regard to the comprehensive impact on outcomes in these athletes. This study aims to systematically review the literature to determine the impacts of early specialization on injury, function, performance, sport success, and psychological outcomes. Methods: A review of Medline (PubMed) was conducted to search for studies relating to early sport specialization in pediatric patients (time of specialization < 18 years old) and outcomes. Extracted information included injury outcomes with a focus on overuse injuries, functional outcomes, performance outcomes, sport success, and psychological outcomes. For studies that reported relevant statistics, p < 0.05 was considered statistically significant. All studies were described qualitatively. Results: An initial search resulted in a total of 826 studies. After applying inclusion and exclusion criteria, 93 studies were included. A total of 62,327 athletes were included in the study. The average age of study participants was 15.9 years, with an average age at specialization of 11.6 years. Early sport specialization was associated with increased risk of injury, worse functional and physical performance, decreased or no benefit to sport success, and poor psychological outcomes. Conclusions: Early sport specialization was associated with increased risk of injury and negative impacts on functional and physical performance measures. There was also no clear advantage regarding sport success. Early sport specialization was linked to harmful effects on athlete psychological well-being. Late specialization, multisport participation, and following training volume guidelines can aid in mitigating these risks.

Smoking is a well-known cause of impairment in wound healing and postoperative outcomes; however, its effects on treating meniscus issues remain unclear. This study assesses the relationship between smoking and meniscus treatment outcomes. PubMed, Scopus, Cochrane, and CINAHL were searched from inception to 24 December 2023. Inclusion criteria encompassed studies examining smoking’s impact on patient outcomes regarding meniscus pathology. A secondary PubMed search targeted randomized controlled trials (RCTs) in the top ten orthopedic journals focusing on meniscus pathology and smoking as a demographic variable. Meta-analysis of six studies (n = 528) assessed meniscus failure rate based on smoking status. Eighteen observational studies (n = 8353 patients; 53.25% male; mean age: 51.35 ± 11.53 years; follow-up: 184.11 ± 117.34 months) were analyzed, covering meniscus repair, meniscectomy, allograft transplant, conservative care, and arthroscopy. Results showed four studies (36.36%) linked smoking with worse meniscus repair outcomes, while seven studies (63.64%) did not find significant associations. Meta-analysis from six studies showed no significant impact of smoking on repair failure (p = 0.118). Regarding meniscectomy, one study (33.33%) identified a significant association with smoking, but two did not. Only one (3.8%) of the RCTs in leading orthopedic journals included smoking as a factor. The evidence on smoking’s effect on meniscus treatment is mixed, necessitating further investigation.