Sports & Athletes

Elbow injuries in throwing athletes: UCL pathology & reconstruction, medial epicondylitis, and considerations for return-to-play protocols.

Overview

Management of sports-related musculoskeletal injuries requires balancing immediate clinical needs with long-term athletic performance goals. For pediatric and adolescent soccer players with lumbar spondylolysis, cessation of sports for 3 months optimizes clinical outcomes and strongly predicts favorable return to sport [5]. In cases of core muscle injury producing groin pain, surgery is indicated for athletes who fail nonsurgical management to facilitate return to sport [12]. Similarly, femoroacetabular impingement surgical treatment in swimmers yields excellent outcomes, including return to sport at a level of performance superior to pre-injury status when indicated [42]. Primary hip arthroscopy also demonstrates favorable outcomes and high rates of clinical benefit at 5-year follow-up [51].

Surgical decision-making for ulnar collateral ligament (UCL) injuries must be tailored to the patient’s sport and level of competition to optimize return to sport and minimize complication and reinjury risk [53]. Consensus indicates surgery for professional athletes and those with complete UCL tears, while opinion remains divided on treating partial tears or nonprofessionals [17]. UCL repair and reconstruction offer similar return to sport rates with low complication rates [53]. For anterior shoulder instability, return to sport rates vary based on procedure type, clinical follow-up duration, athletic level, and revision surgery status [49].

Return to sport criteria must extend beyond time-based metrics. The definitive decision for return to sport after ACL reconstruction should rely on patient-related and sports-demand factors, as most athletes are not ready for a safe return 8 months postoperatively [8]. There is an urgent need for robust, operationalized, and sport-specific return to performance criteria to support clinical decision-making in soccer after musculoskeletal injury [48]. Currently, patient-reported outcome measures (PROMs) are not tailored for athletes and high-performance sports practitioners, lacking standardization in postoperative evaluation [40]. Athletes who did not return to sport for reasons unrelated to their hip demonstrate favorable outcomes at minimum 2- and 5-year follow-up after high-level athletic intervention [33]. Cell-based therapies and regenerative medicine offer safe, potentially efficacious treatments for sports-related injuries, though more clinical evidence is necessary to define indications and parameters [14].

Anatomy & Pathophysiology

Kinematics and Biomechanics

Understanding the biomechanics of the elbow during sports activities, including forces, torques, and muscle activities, helps physicians understand injury mechanisms and minimize potential risk for injury while maximizing performance [59]. The biomechanics of the throwing motion involve specific diagnosis and treatment considerations for elbow injuries common to throwers other than ulnar collateral ligament injuries [63]. Most research shows that elbow loads in throwing or serving are not generated or regulated solely by local muscles and ligaments; distant body segments generate forces and provide mechanisms to regulate loads for optimal performance with minimal injury risk [116].

Valgus torque at the elbow during baseball pitching is associated with 6 biomechanical variables of sequential body motion in adult baseball pitchers [109]. Pitch velocity was the most influential variable in predicting pitching arm kinetics, but pitching mechanics also significantly influenced both elbow and shoulder stress [88]. Kinetic and rotational kinematic differences between professional and high school pitchers may help explain greater performance in professionals while allowing them to minimize elbow varus torque during pitching [111]. Although pitching kinematics and kinetics in young female players were significantly lower than in young male players, the kinematics and kinetics causing increases in elbow joint load showed a sex difference, with those in young female players depending on shoulder kinematics [112].

Modifiable Risk Factors and Mechanics

Determining individual mechanics that decrease elbow varus torque may help coaches and trainers correct these patterns [84]. Players can throw at close to half effort to reduce elbow kinetics while maintaining kinematics occurring at 100% effort pitching [67]. Increasing pitch count is associated with increasing elbow flexion angle at ball release in youth baseball pitchers [86]. Pitching with fatigue may cause biomechanical changes associated with increased rates of elbow injury in the adult throwing population [86].

Forearm position was not associated with the elbow varus moment, but the supination moment was associated with the elbow varus moment in collegiate baseball pitchers [108]. No kinematic or kinetic differences were noted between throwing balls and strikes in professional baseball pitchers [110]. Elbow angle significantly influenced muscle activation patterns and force output during the concentric phase of the push-up plus exercise [106].

Developmental and Demographic Considerations

Elbow and shoulder kinetics increase with time, particularly after age 13 [87]. Increased medial elbow torque was associated with greater ball velocity regardless of the history of medial elbow injuries in youth baseball pitchers [114]. Boys demonstrate greater knee frontal moments than girls during the impact phase of cutting maneuvers, despite age-related increases in girls [119].

Measurement and Surgical Outcomes

Sensors provide a precise and reproducible method for measuring torque across the medial elbow, as well as additional parameters of arm speed, arm slot, and shoulder rotation [104]. Ulnar collateral ligament reconstruction using a suspension button fixation technique reliably restored elbow kinematics to the intact state [113].

Shoulder-Elbow Interplay

Updates on the thrower's shoulder anatomy, mechanics, pathomechanics, and treatment are essential for clinicians and researchers treating or investigating the shoulder [107]. Chronic structural adaptations of the shoulder and elbow are correlated in professional baseball pitchers, but no significant relationships were found between adaptations in shoulder strength or ROM and chronic structural adaptations of the elbow [117].

Classification

Femoroacetabular Impingement (FAI): FAI is a condition in athletes where proper recognition and treatment allow most to return to sports, though long-term implications of high-level activities must be considered [2]. Hip injuries sustained by athletes playing impingement-type sports have a significantly higher rate of surgical intervention than other sport classifications [72].

Extreme Sports: Management of injured extreme sports athletes presents challenges due to differences in temperament, epidemiology, initial management, treatment decisions, and rehabilitation compared to traditional sports [3].

Gender-Based Classification: Distinct differences exist in the diagnosis, treatment, and type of sports activity between female and male competitive athletes undergoing arthroscopic hip surgery [6]. Sports injuries in young males and females differ by injury type, diagnosis, and body area [10]. Potential causes for gender differences in reported recovery time from sports-related concussion include sports specialization, level of play, injury education, and training regimens [78].

Specialization and Age: High school athletes specialized at an earlier age than current collegiate or professional athletes and recalled a higher incidence of sports-related injury attributed to specialization [23].

Position-Specific Injury Patterns: There are definitive trends in the types of shoulder injuries per player position in elite collegiate football players [55]. Injury patterns are associated with certain sports during anterior cruciate ligament reconstruction [77].

Sport-Specific Return-to-Sport (RTS) Factors: Sports type is the only factor associated with complete return to sports (RTS) after arthroscopic Bankart repair in teenage athletes [76]. Hip rehabilitation intervention should be based on impairments and functional limitations identified using structured evaluation, considering the known characteristics of specific athletes [83].

Exposure and Definition Variability: Variability between studies on injury rates in men’s elite ice hockey is explained by differences in the definitions of both injury and athlete exposure [61]. The incidence of season-ending shoulder injuries in the National Collegiate Athletic Association varies widely by sport and injury, with a number of associated risk factors [90].

Olympic vs. Professional Context: Within Olympic seasons, an increase was noted in certain categories of injuries to National Hockey League players on Olympic rosters versus those who were not [81].

Other Considerations: The Return-to-Sport Clearance Continuum proposes an evolving continuum of healing and testing rather than a single decision point to help professional athletes return to sport at their maximal performance level safely and timely [89].

Clinical Presentation

A systematic approach involving history, physical examination, imaging, and sport-specific treatment algorithms facilitates symptomatic improvement and return to play in athletes with back pain [1]. Distinct differences in diagnosis, treatment, and type of sports activity exist between female and male competitive athletes undergoing arthroscopic hip surgery [6]. Sports injuries in young males and females differ by injury type, diagnosis, and body area [10]. Significant injuries and diagnoses in professional American football appear congruent with position-specific demands placed on the athletes [35].

Acute Injury vs. Chronic Pathology

Symptomatic femoroacetabular impingement causes substantial reductions in athletic performance compared to healthy competitors, placing these athletes at a distinct performance disadvantage [36]. Most athletes with femoroacetabular impingement can expect to return to sports with proper recognition and treatment, although long-term implications of high-level activities must be considered [2]. Jumper's knee symptoms are often serious and result in long-standing impairment of athletic performance among elite athletes [7]. Proximal hamstring strains of the stretching type generally imply a prolonged rehabilitation period before returning to sport, despite relatively mild initial symptoms [9]. Early diagnosis and surgical repair of avulsion injury of the serratus anterior muscle allow for a successful return to competitive sports [32]. Young athletes provide good clinical results and a 100% return to sports rate after acute meniscus repair, even though MRI alterations may still be present [11].

Neurological and Systemic Red Flags

Sport-related concussions are heterogeneous and require an individualized clinical approach [30]. Current evidence is mixed regarding sex differences in cognitive performance after a sport concussion; female athletes have a higher symptom burden before and after injury, and athletes should be managed based on clinical presentation regardless of biological sex [24]. Female athletes may be more susceptible to concussion, have prolonged symptoms after a concussion, and are more likely to report a concussion than their male counterparts [34]. Concussions were the most common injury diagnosis in intercollegiate water polo athletes, had the worst return-to-play outcomes among common diagnoses, and were mostly sustained outside of competition [26]. A thorough understanding of epidemiology, screening methods, and the differentiation of pathology from benign athlete's heart changes is essential for sports medicine physicians regarding cardiac issues in athletes [25]. Exertional heat-related illness is a frequently encountered but preventable issue that remains a leading cause of death in athletes, requiring clinicians to understand its diagnosis, recognition, and management [28].

Vascular and Special Considerations

Clinician awareness of Paget-Schroetter syndrome in athletes is critical to avoid delays in treatment and misdiagnosis, and to allow for timely return to sport with minimal complications [29]. The management of injured extreme sports athletes presents challenges due to differences in temperament, epidemiology, initial management, treatment decisions, and rehabilitation compared to traditional sports [3]. Discerning characteristics among different shoulder injuries are important for proper diagnosis and treatment planning to aid competitive swimmers in returning to competition [27]. Predictive tests may help identify patients at risk of not returning to pre-injury sport 6 months following anterior cruciate ligament reconstruction surgery [31].

Investigations

A systematic approach involving history, physical examination, imaging, and sport-specific treatment algorithms can facilitate symptomatic improvement and return to play in athletes with back pain [1].

Plain radiography: In more than one-quarter of patients, plain radiographs may help to establish the diagnosis of an ACL tear [101].

MRI: Abnormal magnetic resonance imaging findings are common in asymptomatic athletes, which decreases the value of magnetic resonance imaging in surgical decision-making for osteitis pubis [46]. Unenhanced magnetic resonance imaging of the shoulder in asymptomatic high performance throwing athletes reveals abnormalities that may encompass a spectrum of nonclinical findings [62]. Awareness of the os acromiale in the young athlete, appropriate clinical examination, and image studies are crucial to confirm diagnosis [95].

For stress fractures, both location of the injury and severity determined by imaging should be considered for prediction of return-to-sports-time [54]. MRI evidence suggests that CAM impingement is more common in elite ice hockey athletes compared with non-athletes [75]. A cross-section of young and elite athletic population showed a total of 197 full-thickness chondral injuries evident on MRI, representing 20.1% among all players and 38.2% of those with MRI scans [80]. Athletes with an MRI grade 0-2 adductor injury were clinically pain-free after approximately 2 weeks and returned to full team training after approximately 3 weeks [82]. Professional baseball players who suffer a latissimus dorsi or teres major tendon injury have predictable clinical presentations and imaging findings [85]. Progressive elbow magnetic resonance imaging abnormalities in Little League baseball players are common, with findings tending to progress especially among athletes who play baseball year-round [93]. Significant findings assessing MRI measurements of the epiphyseal plate in asymptomatic adolescent elite tennis players might reflect a development of consecutive alterations in the epiphyseal plate in the dominant arm [97].

Regarding post-operative and degenerative markers, MRI results determined at long-term follow-up did not conclusively correlate with long-term sporting activity after first-generation autologous chondrocyte implantation in the knee joint [71]. MRI markers of early cartilage degeneration were identified in the medial compartment of the involved knee in young athletes 5-year post-return-to-sport after ACL reconstruction [74]. Lower patient-reported function at 2 years is associated with elevated knee cartilage T1rho and T2 relaxation times at 5 years in young athletes after ACL reconstruction [74]. Nonoperative management of MRI-documented isolated grade III lateral collateral ligament injuries in NFL athletes results in more rapid return to play without subjecting the player to the risks of surgery, while achieving an equal likelihood of return to play at the professional level [98].

CT: Systematic radiological examination of the lumbar spine is recommended for athletes considered to be at greater risk of developing spondylolysis [91].

Other Considerations: Young athletes provide good clinical results and a 100% return to sports rate after acute meniscus repair even though MRI alterations are still present [11]. Microfracture technique can offer clinical, functional and subjective improvement in athletically active patients with full thickness chondral lesions of the knee [100].

Treatment

Non-Operative

Conservative management remains a viable initial strategy for several athletic injuries, though outcomes vary by pathology. Nonoperative treatment of ulnar collateral ligament (UCL) injuries in throwing athletes allows 42% of athletes to return to their previous level of competition at an average of 24.5 weeks after diagnosis [19]. Similarly, non-operative management of isolated Grade I-II lateral collateral ligament injuries in elite athletes is associated with 100% return to pre-injury level of sport, reasonable recovery times, and no significant residual varus instability [68]. For patellar tendinopathy, physical therapy yields a generally acceptable long-term prognosis [4]. In pediatric and adolescent soccer players with lumbar spondylolysis, cessation of sports for 3 months optimizes clinical outcomes and is a strong predictor of favorable return to sports [5]. However, conservative treatment of pectoralis major rupture in athletes leads to significant strength loss and prevents return to competitive sports [65]. Bracing is not effective as an adjunct to standard nonoperative management in allowing scholastic athletes with unstable shoulders to return and complete a subsequent season [43].

Operative

Indications: Surgery is indicated for athletes with core muscle injury producing groin pain who fail nonsurgical management to allow return to sport [12]. For ulnar collateral ligament injuries, professional athletes and those with complete UCL tears are indicated for surgery by consensus, whereas opinion is divided on treating partial tears or nonprofessionals [17]. Conservative management of clavicular fractures results in return to sport 40% faster than surgery, though this appears associated with the severity and complexity of fractures treated surgically [69].

Surgical Approach / Technique: Arthroscopic repair appears to be an effective and reproducible treatment option for athletes with symptomatic multidirectional shoulder instability [38]. Arthroscopic treatment of traumatic posterior shoulder instability resulted in 95.2% excellent outcomes according to the Rowe score, with athletes returning to recreational sports activities at the same level [45]. Hip arthroscopic surgery is effective for femoroacetabular impingement treatment in high-level female athletes, with outcomes similar to those in patients with lower sports activity levels [41]. Ulnar collateral ligament reconstruction using a cortical button suspension technique demonstrated a high rate of return to sport (82.6%) and good functional outcomes [47].

Other Considerations: The decision for return to sports after ACL reconstruction should be based on patient-related and sports-demand factors rather than time alone, as most athletes were not ready for a safe return 8 months postoperatively [8]. Anterior cruciate ligament-injured patients following nonoperative treatment and operatively treated patients did not have significantly different rates of returning to pivoting sports after 1 year [66]. In non-elite athletes, 65% returned to sports after anterior cruciate ligament reconstruction, with 43% returning at their preinjury level [70]. Patients treated with either nonoperative or operative management for osteochondritis dissecans of the femoral trochlea returned to sport at a high rate, and those requiring operative management had a low revision rate [60]. Athletes undergoing meniscal allograft transplantation had significant improvements in most outcome measures [44]. Patients who desire to continue sports may safely consider total knee arthroplasty, as sports activity is maintained or increased following the procedure [50].

Adjuncts / Regenerative: Cell-based therapies and regenerative medicine offer safe and potentially efficacious treatment for sports-related musculoskeletal injuries, but more clinical evidence is necessary to define indications and parameters for their use [14].

Other Considerations: Most athletes with femoroacetabular impingement can expect to return to sports with proper recognition and treatment, although long-term implications of high-level activities must be considered [2]. Proper treatment, appropriate intervention, and understanding of injury prevention guidelines allow skeletally immature throwing athletes to undergo timely recovery and return to sport with minimal long-term effect [13]. Adolescent athletes should avoid sport specialization when possible, as it is a risk factor for overuse injuries but not acute lower extremity injuries [52]. Management of injured extreme sports athletes presents challenges due to differences in temperament, epidemiology, initial management, treatment decisions, and rehabilitation compared to traditional sports [3]. Team physician consensus statements provide guidelines that best serve the healthcare needs of athletes and teams [56]. There is a severe lack of evidence on athlete characteristics and clinical course of nonreturning athletes after hip arthroscopy for femoroacetabular impingement syndrome, and the rate of subsequent hip procedures is unknown [57]. The level of evidence for return to sport after surgical treatment for high-grade acromioclavicular dislocation is low, and methodological heterogeneity prevented feasible subgroup analyses [37]. Most studies on professional baseball report return to play to determine treatment efficacy, but significant variability exists in how players are followed [39].

Complications

General Management & Prognosis: A systematic approach involving history, physical examination, imaging, and sport-specific treatment algorithms facilitates symptomatic improvement and return to play for back pain in athletes [1]. Athletes with patellar tendinopathy receiving physical therapy have a generally acceptable long-term prognosis [4]. Proper treatment, appropriate intervention, and a thorough understanding of injury prevention guidelines allow skeletally immature throwing athletes to undergo timely recovery and return to sport participation with minimal long-term effect [13].

Arthroplasty & Joint Preservation Outcomes: Sports and physical activity do not negatively impact survivorship of the knee prosthesis at mid-term follow-up after total knee arthroplasty [15]. Thirty-five athletes (78%) remain active in professional sport at an average follow-up of 1.6 years following arthroscopic decompression for femoroacetabular impingement [16]. High body mass index did not adversely affect outcomes of high-level athletes undergoing primary hip arthroscopy at short-term follow-up [18]. Long-lasting clinical improvements and high return to sport rates can be expected after pediatric and adolescent anterior cruciate ligament reconstruction [20]. At a minimum of 2-year follow-up, nearly 90% of adolescent baseball players returned to their preinjury level of sport after ulnar collateral ligament reconstruction [21]. Six out of ten patients with sinus tarsi syndrome returned to pre-injury type of sport after subtalar arthroscopy [22]. Subtalar arthroscopy yields effective outcomes at long-term follow-up concerning patient-reported outcome measures in athletic population, with favorable return to sport level, return to sport time, clinical outcomes and safety outcome measures [22].

Re-injury & Secondary Complications: In the 24 months after anterior cruciate ligament reconstruction and return to sport, patients are at a greater risk to suffer a subsequent ACL injury compared with young athletes without a history of ACL injuries [79]. A history of anterior cruciate ligament reconstruction is a risk factor for further injury, with the highest risk in the first year after reconstruction [99]. More experienced and established athletes are more likely to return to competition at the same level after anterior cruciate ligament reconstruction than those with less professional experience [102]. Athletes who had a history of knee surgery before participation in collegiate athletics miss more days due to injury, have increased rates of knee injury and knee surgery, and require more MRIs during their collegiate careers than their peers [94]. A history of meniscectomy, but not ACL reconstruction, shortens the expected career of a professional football player [105]. Proximal hamstring strains of the stretching type generally imply a prolonged rehabilitation period before returning to sport, despite relatively mild initial symptoms [9]. Jumper's knee causes mild but long-lasting symptoms after an athletic career [92].

Other Considerations: Early sport specialization is an independent risk factor for chronic overuse lower extremity injuries in youth athletes [96]. High school athletes specialized at an earlier age than current collegiate or professional athletes and recalled a higher incidence of sports-related injury attributed to specialization [23]. There is a limited number of comprehensive long-term outcome studies that have identified a potential link between early sport specialization and musculoskeletal injury or burnout [58]. Training >8 months out of the year in a single sport is associated with sports-related concussion and prior history of concussion [103]. The pitch clock has not increased short-term injury risk in Major League Baseball, although ongoing research is needed to assess its long-term effects [64].

Recovery

A systematic approach involving history, physical examination, imaging, and sport-specific treatment algorithms can facilitate symptomatic improvement and return to play in athletes with back pain [1]. With proper recognition and treatment, most athletes with femoroacetabular impingement can expect to return to sports [2]. Athletes with patellar tendinopathy receiving physical therapy can expect a generally acceptable long-term prognosis [4]. Sports and physical activity do not negatively impact survivorship of the knee prosthesis at mid-term follow-up after total knee arthroplasty [15].

Light activity (weeks): Desk work, driving, and light activities of daily living are typically resumed within weeks for many procedures, though specific timelines vary by injury. For example, return to sports can be expected at approximately 13 weeks after injury for high-performance athletes with complete proximal adductor avulsion treated nonoperatively, but can take even longer [124]. An early return to sports is possible after plate fixation of displaced midshaft clavicle fractures, but the time to return is highly variable [115].

Full activity (months): Return to sport timelines depend heavily on the pathology and intervention. The average time for return to sport was 5.8 months after microscopic lumbar diskectomy in professional athletes [118]. Athletes with femoroacetabular impingement took an average of 4.7 months to return to sports activities after hip arthroscopy, with 87% returning to the same level of practice they had before symptoms appeared [122]. An accelerated rehabilitation programme after arthroscopic Bankart repair resulted in a return to play time of 11 weeks in professional footballers, compared to previously reported times of between 5 months and 9 months in the contact sports population [120]. Cessation of sports for a period of 3 months can optimize the clinical outcome and is a strong predictor of a favorable return to sports in pediatric and adolescent soccer players with lumbar spondylolysis [5]. Nonoperative treatment allowed 42% of throwing athletes with ulnar collateral ligament injuries to return to their previous level of competition at an average of 24.5 weeks after diagnosis [19]. Surgical treatment of distal hamstring tendon injuries yields a higher return-to-sports rate than conservative treatment, as 53.6% of patients initially treated conservatively required surgery, delaying return to sports time without affecting the final return-to-sports rate [121].

Complete recovery / outcome plateau (months): Long-term outcomes and stability of return to sport vary by condition. At a minimum of 2-year follow-up, nearly 90% of adolescent baseball players returned to their preinjury level of sport after ulnar collateral ligament reconstruction [21]. Long-lasting clinical improvements and high return to sport rates can be expected after pediatric and adolescent anterior cruciate ligament reconstruction [20]. Subtalar arthroscopy yields effective outcomes at long-term follow-up concerning patient-reported outcome measures in athletic population, with favorable return to sport level, return to sport time, clinical outcomes and safety outcome measures for patients with sinus tarsi syndrome [22]. Thirty-five athletes (78%) remain active in professional sport at an average follow-up of 1.6 years following arthroscopic decompression for femoroacetabular impingement [16]. All athletes returned to athletic activity at a level similar to the preintervention period after arthroscopic xenograft bone block associated with Bankart repair and subscapularis augmentation for recurrent anterior shoulder instability [123].

Rehabilitation protocol: Rehabilitation strategies significantly influence return-to-sport metrics. An accelerated rehabilitation programme after arthroscopic Bankart repair resulted in a return to play time of 11 weeks in professional footballers, compared to previously reported times of between 5 months and 9 months in the contact sports population [120]. For distal hamstring tendon injuries, conservative treatment delays return to sports time without affecting the final return-to-sports rate, as 53.6% of patients initially treated conservatively required surgery [121].

Functional milestones: Prognosis and functional outcomes are generally favorable for many athletic populations. Athletes with patellar tendinopathy receiving physical therapy can expect a generally acceptable long-term prognosis [4]. At short-term follow-up, high BMI did not adversely affect outcomes of high-level athletes undergoing primary hip arthroscopy [18]. However, Jumper's knee symptoms are often serious, resulting in long-standing impairment of athletic performance [7]. Adolescent athletes had a high failure rate of revision stabilization surgery and modest functional outcomes at a mean of 5.5 years' follow-up [73].

Key Evidence

• [L5] A systematic approach involving history, physical examination, imaging, and sport-specific treatment algorithms can facilitate symptomatic improvement and return to play. (10.5435/00124635-200612000-00004)
• [L5] With proper recognition and treatment, most athletes can expect to return to sports, although the long-term implications of high-level activities must still be considered. (10.1177/0363546513499136)
• [L4] The management of the injured extreme sports athlete is a challenge to surgeons and sports physicians due to differences in temperament, epidemiology, initial management, treatment decisions, and rehabilitation compared to traditional sports. (10.1186/s13018-017-0560-9)
• [L3] Athletes with PT after physical therapy can expect a generally acceptable long-term prognosis. (10.1177/03635465251336466)
• [L4] Cessation of sports for a period of 3 months can optimize the clinical outcome and is a strong predictor of a favorable return to sports. (10.1177/0363546505275645)
• [L3] Distinct differences in the diagnosis, treatment, and type of sports activity between sexes were seen. (10.1177/0363546517697296)
• [L4] The symptoms are often serious, resulting in long-standing impairment of athletic performance. (10.1177/0363546504270454)
• [L5] The definitive decision for return to sports should be based on patient-related and sports-demand factors rather than time alone, as most athletes were not ready for a safe return 8 months postoperatively. (10.1007/s00167-015-3600-1)
• [L4] It is important to inform the subject that this type of injury, despite its relatively mild initial symptoms, generally implies a prolonged rehabilitation period before returning to sport. (10.1177/0363546508315892)
• [L3] Sports injuries in young males and females differed by injury type, diagnosis, and body area. (10.1177/0363546514522393)
• [L4] Young athletes provide good clinical results and a 100% return to sports rate even though MRI alterations are still present. (10.1007/s00167-018-5335-2)
• [L5] Surgery is indicated for athletes who fail nonsurgical management to allow return to sport. (10.5435/jaaos-d-22-00739)
• [L5] Proper treatment, appropriate intervention, and a thorough understanding of injury prevention guidelines can allow these young athletes to undergo a timely recovery and return to sport participation with minimal long-term effect. (10.5435/jaaos-d-25-00186)
• [L4] Cell-based therapies and regenerative medicine offer safe and potentially efficacious treatment for sports-related musculoskeletal injuries, but more clinical evidence is necessary to define the indications and parameters for their use. (10.1177/2325967113519935)
• [L3] Sports and physical activity do not negatively impact survivorship of the knee prosthesis at mid-term follow-up. (10.1007/s00167-022-07025-z)
• [L4] Thirty-five athletes (78%) remain active in professional sport at an average follow-up of 1.6 years. (10.1007/s00167-007-0332-x)
• [L4] Professional athletes and those with complete tears were indicated for surgery by consensus, whereas opinion was more divided on how to treat partial tears or nonprofessionals. (10.1016/j.jse.2017.08.005)
• [L3] At short-term follow-up, high BMI did not adversely affect outcomes of high-level athletes undergoing primary hip arthroscopy. (10.1177/03635465211062910)
• [L4] Nonoperative treatment allowed 42% of athletes to return to their previous level of competition at an average of 24.5 weeks after diagnosis. (10.1177/03635465010290010601)
• [L3] Long-lasting clinical improvements and high return to sport rates can be expected after pediatric and adolescent ACL reconstruction. (10.1177/03635465251320415)
• [L4] At a minimum of 2-year follow-up, nearly 90% of patients returned to their preinjury level of sport. (10.1177/2325967118769328)
• [L4] Subtalar arthroscopy yields effective outcomes at long-term follow-up concerning patient-reported outcome measures in athletic population, with favorable return to sport level, return to sport time, clinical outcomes and safety outcome measures. (10.1007/s00167-020-06385-8)
• [L3] High school athletes specialized at an earlier age than current collegiate or professional athletes and recalled a higher incidence of sports-related injury attributed to specialization. (10.1177/2325967117703944)
• [Paper] Current evidence is mixed regarding sex differences in cognitive performance after a sport concussion; female athletes have a higher symptom burden before and after injury, and regardless of biological sex, athletes diagnosed with a sport concussion should be managed based on clinical presentation. (10.1016/j.csm.2017.05.002)
• [L3] Concussions were the most common injury diagnosis, had the worst return-to-play outcomes among common diagnoses, and were mostly sustained outside of competition. (10.1177/23259671221110208)
• [L5] It is important for the athlete, coach, and clinician to be aware of the discerning characteristics among these different injuries to ensure a proper diagnosis and treatment plan to aid the swimmer in his or her return to competition. (10.5435/jaaos-d-15-00313)
• [L4] Clinician awareness of PSS in athletes is critical to avoid delays in treatment and misdiagnosis, and to allow for a timely return to sport with minimal complications. (10.1016/j.jse.2020.05.015)
• [L5] Sport-related concussions are heterogeneous and require an individualized clinical approach. (10.1007/s00167-013-2791-6)
• [L2] Both tests may help to identify patients at risk of not returning to pre-injury sport. (10.1007/s00167-014-3261-5)
• [Case_report] Early diagnosis and surgical repair allow for a successful return to competitive sports. (10.1016/j.jse.2006.12.014)
• [L3] Athletes who did not return to sport for reasons unrelated to their hip demonstrated favorable outcomes at minimum 2- and 5-year follow-up. (10.1016/j.arthro.2021.11.040)
• [L3] This systematic review demonstrates that female athletes may be more susceptible to concussion, have prolonged symptoms after a concussion, and are more likely to report a concussion than their male counterparts. (10.1177/2325967120932306)
• [L3] The significant injuries and diagnoses appear congruent with the position-specific demands placed on the athletes. (10.1177/0363546508329542)
• [L2] Symptomatic FAI causes substantial reductions in athletic performance compared to healthy competitors placing these athletes at a distinct performance disadvantage. (10.1007/s00167-019-05683-0)
• [L4] However, the level of evidence was low and due to methodological heterogeneity between studies, subgroup analyses of return to sport outcomes were not feasible. (10.1007/s00167-019-05528-w)
• [L4] Arthroscopic repair in athletes with symptomatic MDI appears to be an effective, reproducible treatment option. (10.1177/0363546509335464)
• [L1] Most studies reported return to play to determine treatment efficacy, but significant variability was seen in how players were followed. (10.1177/0363546517697690)
• [L4] This systematic review evidences that the 16 selected articles did not present a standardisation in how to evaluate the postoperative outcomes in athletes and high-performance sports practitioners. (10.1136/jisakos-2019-000286)
• [L4] Hip arthroscopic surgery is effective for FAI treatment in high-level female athletes, with outcomes similar to those in patients with lower sports activity levels. (10.1016/j.jisako.2024.02.010)
• [L5] When indicated, femoroacetabular impingement surgical treatment in swimmers results in excellent outcomes including return to sport and frequently at a level of performance superior to pre-injury status. (10.1016/j.arthro.2018.01.032)
• [L3] Bracing is not effective as an adjunct to standard nonoperative management in allowing athletes to return and complete a subsequent season. (10.1016/j.jse.2018.02.027)
• [L4] These athletes also had significant improvements in most outcome measures. (10.1016/j.arthro.2012.10.027)
• [L4] Arthroscopic treatment resulted in 95.2% of excellent outcomes according to the Rowe score and these athletes were able to return to recreational sports activities at the same level. (10.1111/j.1758-5740.2010.00069.x)
• [L4] Abnormal magnetic resonance imaging findings were also common in asymptomatic athletes, which decreases the value of magnetic resonance imaging in surgical decision-making. (10.1177/0363546507305454)
• [L4] The technique demonstrated a high rate of return to sport (82.6%) and good functional outcomes. (10.1016/j.jse.2018.04.009)
• [L1] There is an urgent need for more robust, operationalized, and sport-specific return to performance criteria to support clinical decision-making. (10.1002/ksa.70180)
• [L4] Ranges of return to sport rates are influenced by procedure type, clinical follow-up duration, athletic level, and revision surgery status. (10.1016/j.arthro.2025.07.032)
• [L2] Therefore, patients who want to continue their desired sports may safely consider TKA. (10.1007/s00167-017-4529-3)
• [L4] Athletes who underwent primary hip arthroscopy demonstrated favorable outcomes and high rates of clinical benefit at 5-year follow-up. (10.1016/j.arthro.2022.11.008)
• [L2] Adolescent athletes should avoid specialization when possible. (10.1177/2325967119s00111)
• [L1] Surgeons should base operative decision making on patient sport and level of competition to optimize return to sport and minimize complication and reinjury risk. (10.1016/j.xrrt.2025.02.005)
• [L3] Both location of the injury and severity determined by imaging should therefore be considered for prediction of return-to-sports-time. (10.1186/1471-2474-13-139)
• [L3] There are definitive trends in the types of injuries per player position. (10.1177/0363546505274718)
• [L5] Ultimately, this statement provides guidelines that best serve the health care needs of athletes and teams. (10.1177/03635465000280033002)
• [L1] There is a severe lack of evidence on the athlete characteristics and clinical course of the nonreturning athletes, and the rate of subsequent hip procedures is unknown. (10.1177/0363546520956292)
• [L5] There is a limited number of comprehensive long-term outcome studies that have identified a potential link between early sport specialization and musculoskeletal injury or burnout. (10.2106/jbjs.21.00018)
• [L5] Understanding the biomechanics of the elbow during sports activities, including the forces, torques, and muscle activities involved, helps physicians better understand injury mechanisms and minimize potential risk for injury while maximizing performance. (10.1016/j.csm.2004.06.003)
• [L5] Patients treated with either nonoperative or operative management returned to sport at a high rate, and those requiring operative management had a low revision rate. (10.1002/ksa.12040)
• [L4] The majority of variability between studies is explained by differences in the definitions of both injury and athlete exposure. (10.3390/sports7110227)
• [L4] Unenhanced magnetic resonance imaging of the shoulder in asymptomatic high performance throwing athletes reveals abnormalities that may encompass a spectrum of nonclinical findings. (10.1177/03635465020300012501)
• [L5] The purpose of the present review article is to describe the biomechanics of the throwing motion and the diagnosis and treatment of elbow injuries common to a thrower other than injuries to the ulnar collateral ligament. (10.2106/jbjs.rvw.n.00011)
• [L3] These findings suggest that the pitch clock has not increased short-term injury risk, although ongoing research is needed to assess its long-term effects. (10.1177/23259671251403066)
• [L4] Conservative treatment leads to significant strength loss and prevents return to competitive sports. (10.1007/s001670050085)
• [L3] Anterior cruciate ligament-injured patients following a nonoperative treatment course and operatively treated patients did not have significantly different rates of returning to pivoting sports after 1 year. (10.1177/0363546512458424)
• [L4] These results suggest that players can throw at close to half effort to reduce their elbow kinetics while maintaining kinematics that would be occurring at 100% effort pitching. (10.1177/23259671251356631)
• [L4] Non-operative management of isolated LCL injuries is associated with high return to pre-injury level of sport (100%), reasonable recovery times, and no significant residual varus instability. (10.1177/2325967126s00022)
• [L4] Athletes conservatively managed returned 40% faster than those with surgery, though this appears to be associated with the severity and complexity of fractures treated surgically. (10.1016/j.jse.2021.04.006)
• [L3] 65% of non-elite athletes with an ACL reconstruction returned to sports, 43% at preinjury level. (10.1186/s12891-024-07834-y)
• [L4] The MRI results determined at this time point did not conclusively correlate with long-term sporting activity. (10.1177/0363546517716920)
• [L3] Hip injuries sustained in athletes who played impingement-type sports had a significantly higher rate of surgical intervention than other sport classifications. (10.1016/j.arthro.2019.03.044)
• [L4] At a mean of 5.5 years' follow-up, adolescent athletes had a high failure rate of revision stabilization surgery and modest functional outcomes. (10.1016/j.arthro.2014.05.037)
• [L2] MRI markers of early cartilage degeneration were identified in the medial compartment of the involved knee in young athletes 5-year post-return-to-sport after ACLR. (10.1007/s00167-018-5291-x)
• [L3] MRI evidence suggests that CAM impingement is more common in the elite ice hockey athlete in comparison with non-athletes. (10.1007/s00167-013-2598-5)
• [L3] Sports type was the only factor associated with complete RTS after surgery. (10.1186/s12891-023-06145-y)
• [L3] Injury patterns were associated with certain sports. (10.1177/0363546513501791)
• [L3] Potential causes include sports specialization, level of play, injury education, and training regimens. (10.1177/2325967120s00139)
• [L2] In the 24 months after ACLR and return to sport, patients are at a greater risk to suffer a subsequent ACL injury compared with young athletes without a history of ACL injuries. (10.1177/0363546514530088)
• [L4] The study offers a cross-section of a young and elite athletic population with a total of 197 full-thickness chondral injuries evident on MRI (20.1% among all players, 38.2% of those with MRI scans). (10.1016/j.arthro.2010.01.025)
• [L3] However, within Olympic seasons, an increase was noted in certain categories of injuries to players on Olympic rosters versus those who were not. (10.1177/23259671251389108)
• [L2] Athletes with an MRI grade 0-2 adductor injury were clinically pain-free after approximately 2 weeks and returned to full team training after approximately 3 weeks. (10.1177/2325967119897247)
• [L4] Determining the individual mechanics that decrease elbow varus torque may help coaches and trainers correct these patterns. (10.1177/23259671231202524)
• [L1] Professional baseball players who suffer a LD or TM injury have predictable clinical presentations and imaging findings. (10.1016/j.asmr.2023.100787)
• [L5] These findings demonstrate that pitching with fatigue may cause biomechanical changes that have been associated with increased rates of elbow injury in the adult throwing population. (10.1016/j.jse.2024.05.050)
• [L3] Elbow and shoulder kinetics increase with time, particularly after age 13. (10.1177/0363546517732034)
• [L3] Pitch velocity was the most influential variable in both models, but pitching mechanics also significantly influenced both elbow and shoulder stress. (10.1177/03635465211054506)
• [L5] The Return-to-Sport Clearance Continuum proposes an evolving continuum of healing and testing rather than a single decision point to help professional athletes return to sport at their maximal performance level safely and timely. (10.1016/j.asmr.2021.10.026)
• [L3] Incidence of these injuries varies widely by sport and injury, with a number of associated risk factors. (10.1177/0363546518773062)
• [L4] We recommend systematic radiological examination of the lumbar spine in athletes considered to be at greater risk of developing spondylolysis. (10.1177/03635465000280012101)
• [L3] Jumper's knee causes mild but long-lasting symptoms after an athletic career. (10.1177/03635465020300051001)
• [L2] This 3-year longitudinal evaluation suggests that these findings on MRI tend to progress, especially among athletes who play baseball year-round. (10.1177/0363546519888647)
• [L3] Athletes who had a history of knee surgery before participation in collegiate athletics miss more days due to injury, have increased rates of knee injury and knee surgery, and require more MRIs during their collegiate careers than their peers. (10.1177/0363546513519951)
• [L4] Awareness of the os acromiale in the young athlete, appropriate clinical examination, and image studies are crucial to confirm diagnosis. (10.1016/j.jseint.2020.02.008)
• [L5] Early sport specialisation is an independent risk factor for chronic overuse lower extremity injuries in youth athletes, and sport diversification is recommended to minimise injury risk and support long-term athletic development. (10.1136/jisakos-2019-000288)
• [L4] Significant findings assessing MRI measurements of the epiphyseal plate in the asymptomatic adolescent elite tennis player might reflect a development of consecutive alterations in the epiphyseal plate in the dominant arm. (10.1007/s00167-016-4024-2)
• [L3] Nonoperative management of MRI-documented isolated grade III lateral collateral ligament injuries in NFL athletes results in more rapid return to play without subjecting the player to the risks of surgery, while achieving an equal likelihood of return to play at the professional level. (10.1177/0363546509344075)
• [L2] A history of anterior cruciate ligament reconstruction is a risk factor for further injury, with the highest risk in the first year after reconstruction. (10.1177/03635465010290021301)
• [L4] Microfracture technique can offer clinical, functional and subjective improvement in athletically active patients. (10.1007/s00167-004-0499-3)
• [L4] In more than one-quarter of patients, plain radiographs may help to establish the diagnosis of an ACL tear. (10.1007/s00167-014-3022-5)
• [L4] More experienced and established athletes are more likely to return to competition at the same level after this procedure than those with less professional experience. (10.1177/0363546510372798)
• [L3] Training >8 months out of the year in a single sport is associated with sports-related concussion and prior history of concussion. (10.1177/2325967121s00537)
• [L3] The sensor is a precise and reproducible device for measuring torque across the medial elbow, as well as additional parameters of arm speed, arm slot, and shoulder rotation. (10.1016/j.arthro.2017.09.045)
• [L3] A history of meniscectomy, but not ACL reconstruction, shortens the expected career of a professional football player. (10.1177/0363546509349035)
• [L3] Elbow angle significantly influenced muscle activation patterns and force output during the concentric phase of the exercise. (10.1186/s12891-015-0486-5)
• [L5] Updates on the thrower's shoulder, including anatomy, mechanics, pathomechanics, and treatment, are essential for clinicians and researchers treating or investigating the shoulder. (10.1016/j.arthro.2022.02.024)
• [L4] The results demonstrated that forearm position was not associated with the elbow varus moment, but the supination moment was associated with the elbow varus moment. (10.1177/0363546517733471)
• [L4] Valgus torque at the elbow during baseball pitching is associated with 6 biomechanical variables of sequential body motion. (10.1177/0363546509336721)
• [L3] No kinematic or kinetic differences were noted between throwing balls and strikes. (10.1177/0363546517730052)
• [L4] The kinetic and rotational kinematic differences observed between PRO and HS pitchers may help explain the greater performance of PRO pitchers while allowing them to minimize elbow varus torque during pitching. (10.1177/2325967118760780)
• [L4] Although the pitching kinematics and kinetics in young female players were significantly lower than those in young male players, the pitching kinematics and kinetics that cause increases in the elbow joint load had a sex difference, and those in young female players depended on shoulder kinematics. (10.1177/23259671251343795)
• [L5] Ulnar collateral ligament reconstruction using a suspension button fixation technique reliably restored elbow kinematics to the intact state. (10.1177/0363546509350109)
• [L2] Increased medial elbow torque was associated with greater ball velocity regardless of the history of medial elbow injuries. (10.1016/j.arthro.2022.07.016)
• [L4] An early return to sports is possible; however, the time to return is highly variable. (10.1177/0363546513501494)
• [L5] Most research shows that elbow loads in throwing or serving are not generated or regulated solely by local muscles and ligaments; distant body segments generate forces and provide mechanisms to regulate loads for optimal performance with minimal injury risk. (10.1016/j.csm.2004.04.010)
• [L3] However, no significant relationships between adaptations in shoulder strength or ROM were related to chronic structural adaptations of the elbow. (10.1177/03635465251317509)
• [L4] The average time for return to sport was 5.8 months. (10.1177/0363546512458570)
• [L2] The role of kinematics in mediating the KFM0-70 provides means for modification of this risk factor, but as boys had higher joint moments, continued investigation into sex-dependent biomechanical risk factors is warranted. (10.1007/s00167-023-07340-z)
• [L4] An accelerated rehabilitation programme resulted in a return to play time of 11 weeks compared to previously reported times of between 5 months and 9 months in the contact sports population. (10.1177/1758573216647898)
• [L4] Furthermore, 53.6% of patients initially treated conservatively required surgery, delaying return to sports time without affecting the final return-to-sports rate. (10.1002/ksa.12075)
• [L4] They took an average of 4.7 months to return to sports activities, with 87% returning to the same level of practice they had before symptoms appeared. (10.1177/2325967117s00022)
• [L4] All athletes returned to athletic activity at a level similar to the preintervention period. (10.1016/j.jse.2024.05.047)
• [L4] Return to sports can be expected at approximately 13 weeks after injury, but can take even longer. (10.1007/s00167-015-3669-6)

See Also

• Ligament Injuries

References

[1] Back Pain in Athletes. Journal of the American Academy of Orthopaedic Surgeons. 2006. DOI: 10.5435/00124635-200612000-00004

[2] Femoroacetabular Impingement in Athletes. The American Journal of Sports Medicine. 2013. DOI: 10.1177/0363546513499136

[3] Injuries in extreme sports. Journal of Orthopaedic Surgery and Research. 2017. DOI: 10.1186/s13018-017-0560-9

[4] Long-term Prognosis of Athletes With Patellar Tendinopathy Receiving Physical Therapy: Patient-Reported Outcomes at 5-Year Follow-up. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465251336466

[5] Lumbar Spondylolysis in Pediatric and Adolescent Soccer Players. The American Journal of Sports Medicine. 2005. DOI: 10.1177/0363546505275645

[6] Arthroscopic Hip Surgery in the Elite Athlete: Comparison of Female and Male Competitive Athletes. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517697296

[7] Prevalence of Jumper's Knee among Elite Athletes from Different Sports: A Cross-sectional Study. The American Journal of Sports Medicine. 2005. DOI: 10.1177/0363546504270454

[8] Return to sports after ACL reconstruction: individual considerations. Knee Surgery, Sports Traumatology, Arthroscopy. 2015. DOI: 10.1007/s00167-015-3600-1

[9] Proximal Hamstring Strains of Stretching Type in Different Sports. The American Journal of Sports Medicine. 2008. DOI: 10.1177/0363546508315892

[10] Pediatric Sports Injuries. The American Journal of Sports Medicine. 2014. DOI: 10.1177/0363546514522393

[11] High short‐term return to sports rate despite an ongoing healing process after acute meniscus repair in young athletes. Knee Surgery, Sports Traumatology, Arthroscopy. 2018. DOI: 10.1007/s00167-018-5335-2

[12] Core Muscle Injury Producing Groin Pain in the Athlete: Diagnosis and Treatment. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-22-00739

[13] Treatment and Prevention of Injuries in Skeletally Immature Throwing Athletes. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-25-00186

[14] Emerging Applications of Stem Cell and Regenerative Medicine to Sports Injuries. Orthopaedic Journal of Sports Medicine. 2014. DOI: 10.1177/2325967113519935

[15] Total knee arthroplasty improves sports activity and the patient‐reported functional outcome at mid‐term follow‐up. Knee Surgery, Sports Traumatology, Arthroscopy. 2022. DOI: 10.1007/s00167-022-07025-z

[16] Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression. Knee Surgery, Sports Traumatology, Arthroscopy. 2007. DOI: 10.1007/s00167-007-0332-x

[17] Management of ulnar collateral ligament injury in throwing athletes: a survey of the American Shoulder and Elbow Surgeons. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2017.08.005

[18] High Body Mass Index Does Not Adversely Affect Outcomes in High-Level Athletes Undergoing Primary Hip Arthroscopy: A Propensity-Matched Comparison With Minimum 2-Year Follow-up. The American Journal of Sports Medicine. 2022. DOI: 10.1177/03635465211062910

[19] Nonoperative Treatment of Ulnar Collateral Ligament Injuries in Throwing Athletes. The American Journal of Sports Medicine. 2001. DOI: 10.1177/03635465010290010601

[20] The Chance to Become an Elite Athlete After Pediatric And Adolescent Anterior Cruciate Ligament Reconstruction. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465251320415

[21] Outcomes and Return to Sport After Ulnar Collateral Ligament Reconstruction in Adolescent Baseball Players. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118769328

[22] Six out of ten patients with sinus tarsi syndrome returned to pre‐injury type of sport after subtalar arthroscopy. Knee Surgery, Sports Traumatology, Arthroscopy. 2020. DOI: 10.1007/s00167-020-06385-8

[23] Early Single-Sport Specialization: A Survey of 3090 High School, Collegiate, and Professional Athletes. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117703944

[24] Sport Concussion and the Female Athlete. Clinics in Sports Medicine. 2017. DOI: 10.1016/j.csm.2017.05.002

[25] Chapter 43 Cardiac Issues in Athletes. 2019.

[26] Injuries Affecting Intercollegiate Water Polo Athletes: A Descriptive Epidemiologic Study. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/23259671221110208

[27] Swimmer’s Shoulder: Painful Shoulder in the Competitive Swimmer. Journal of the American Academy of Orthopaedic Surgeons. 2016. DOI: 10.5435/jaaos-d-15-00313

[28] Chapter 48 Heat Illness and Hydration. 2019.

[29] Paget-Schroetter syndrome in athletes: a comprehensive and systematic review. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.05.015

[30] A comprehensive, targeted approach to the clinical care of athletes following sport‐related concussion. Knee Surgery, Sports Traumatology, Arthroscopy. 2013. DOI: 10.1007/s00167-013-2791-6

[31] Predictive parameters for return to pre-injury level of sport 6 months following anterior cruciate ligament reconstruction surgery. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-014-3261-5

[32] Avulsion injury of the serratus anterior muscle in a high-school underhand pitcher: A case report. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.12.014

[33] High‐Level Athletes Who Did Not Return to Sport for Reasons Unrelated to Their Hip Achieve Successful Midterm Outcomes With a Benchmarking Against High‐Level Athletes Who Returned to Sport. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2021.11.040

[34] Sport-Related Concussion in Female Athletes: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120932306

[35] Predictive Value of Prior Injury on Career in Professional American Football is Affected by Player Position. The American Journal of Sports Medicine. 2009. DOI: 10.1177/0363546508329542

[36] Arthroscopic correction of femoroacetabular impingement improves athletic performance in male athletes. Knee Surgery, Sports Traumatology, Arthroscopy. 2019. DOI: 10.1007/s00167-019-05683-0

[37] Return to sport after surgical treatment for high‐grade (Rockwood III–VI) acromioclavicular dislocation. Knee Surgery, Sports Traumatology, Arthroscopy. 2019. DOI: 10.1007/s00167-019-05528-w

[38] Arthroscopic Treatment of Multidirectional Shoulder Instability in Athletes. The American Journal of Sports Medicine. 2009. DOI: 10.1177/0363546509335464

[39] Systematic Review of Outcomes Reporting in Professional Baseball: A Call for Increased Validation and Consistency. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517697690

[40] Presently PROMs are not tailored for athletes and high-performance sports practitioners: a systematic review. Journal of ISAKOS. 2019. DOI: 10.1136/jisakos-2019-000286

[41] Hip arthroscopy is an effective treatment for high-level female athletes. Journal of ISAKOS. 2024. DOI: 10.1016/j.jisako.2024.02.010

[42] Editorial Commentary: Don't Forgot the Hip in Swimmers and Multisport Athletes. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.01.032

[43] Does Functional Bracing of the Unstable Shoulder Improve Return to Play in Scholastic Athletes?. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.02.027

[44] Return to High‐Level Sport After Meniscal Allograft Transplantation. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2012.10.027

[45] Arthroscopic Treatment of Traumatic Posterior Shoulder Instability in Athletes. Shoulder & Elbow. 2010. DOI: 10.1111/j.1758-5740.2010.00069.x

[46] Pubic Magnetic Resonance Imaging Findings in Surgically and Conservatively Treated Athletes with Osteitis Pubis Compared to Asymptomatic Athletes during Heavy Training. The American Journal of Sports Medicine. 2007. DOI: 10.1177/0363546507305454

[47] Ulnar collateral ligament reconstruction in athletes using a cortical button suspension technique. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.04.009

[48] Return to performance criteria in soccer after musculoskeletal injury: A scoping review. Knee Surgery, Sports Traumatology, Arthroscopy. 2025. DOI: 10.1002/ksa.70180

[49] Ranges of Return to Sport Outcomes Following Anterior Shoulder Instability Surgery Are Influenced by Procedure, Athletic Level, and Follow-Up Duration: A Systematic Review. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2025. DOI: 10.1016/j.arthro.2025.07.032

[50] Sports activity is maintained or increased following total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy. 2017. DOI: 10.1007/s00167-017-4529-3

[51] Athletes Report Favorable Outcomes at 5‐Year Minimum Follow‐Up After Primary Hip Arthroscopy: A Systematic Review. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.11.008

[52] SPORT SPECIALIZATION IS A RISK FACTOR FOR OVERUSE, BUT NOT ACUTE, LOWER EXTREMITY INJURIES: A PROSPECTIVE STUDY. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119s00111

[53] Ulnar collateral ligament repair and reconstruction have similar return to sport rates with low complication rates: a systematic review and meta-analysis. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2025.02.005

[54] Estimation of return-to-sports-time for athletes with stress fracture – an approach combining risk level of fracture site with severity based on imaging. BMC Musculoskeletal Disorders. 2012. DOI: 10.1186/1471-2474-13-139

[55] Prevalence and Variance of Shoulder Injuries in Elite Collegiate Football Players. The American Journal of Sports Medicine. 2005. DOI: 10.1177/0363546505274718

[56] Team Physician Consensus Statement. The American Journal of Sports Medicine. 2000. DOI: 10.1177/03635465000280033002

[57] Can We Identify Why Athletes Fail to Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement Syndrome? A Systematic Review and Meta-analysis. The American Journal of Sports Medicine. 2020. DOI: 10.1177/0363546520956292

[58] Early Sport Specialization. Journal of Bone and Joint Surgery. 2021. DOI: 10.2106/jbjs.21.00018

[59] Biomechanics of the elbow in sports. Clinics in Sports Medicine. 2004. DOI: 10.1016/j.csm.2004.06.003

[60] High rates of return to sport following management of osteochondritis dissecans of the femoral trochlea: A systematic review. Knee Surgery, Sports Traumatology, Arthroscopy. 2024. DOI: 10.1002/ksa.12040

[61] What Is Injury in Ice Hockey: An Integrative Literature Review on Injury Rates, Injury Definition, and Athlete Exposure in Men’s Elite Ice Hockey. Sports. 2019. DOI: 10.3390/sports7110227

[62] Magnetic Resonance Imaging of the Shoulder in Asymptomatic Professional Baseball Pitchers. The American Journal of Sports Medicine. 2002. DOI: 10.1177/03635465020300012501

[63] Elbow Injuries in the Throwing Athlete. JBJS Reviews. 2014. DOI: 10.2106/jbjs.rvw.n.00011

[64] Pitch Counts and Injury Incidence in Major League Baseball: Responses to Pitch Clocks and Defender Rule Changes. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671251403066

[65] Surgical treatment of pectoralis major rupture in athletes. Knee Surgery, Sports Traumatology, Arthroscopy. 1998. DOI: 10.1007/s001670050085

[66] A Pair-Matched Comparison of Return to Pivoting Sports at 1 Year in Anterior Cruciate Ligament–Injured Patients After a Nonoperative Versus an Operative Treatment Course. The American Journal of Sports Medicine. 2012. DOI: 10.1177/0363546512458424

[67] Differences in Pitching Kinetics and Kinematics During Various Effort Level Pitching. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671251356631

[68] Isolated Clinically Diagnosed Grade I-II Lateral Collateral Ligament Injuries in Elite Athletes Do Not Require Surgery. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967126s00022

[69] Factors influencing time to return to sport following clavicular fractures in adolescent athletes. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.04.006

[70] In non-elite athletes, women are more likely to return to sports after anterior cruciate ligament reconstruction: a retrospective cohort study. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07834-y

[71] Sporting Activity Is Reduced 11 Years After First-Generation Autologous Chondrocyte Implantation in the Knee Joint. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517716920

[72] A Sport‐specific Analysis of the Epidemiology of Hip Injuries in National Collegiate Athletic Association Athletes From 2009 to 2014. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.03.044

[73] Results of Revision Anterior Shoulder Stabilization Surgery in Adolescent Athletes. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.05.037

[74] Lower patient-reported function at 2 years is associated with elevated knee cartilage T1rho and T2 relaxation times at 5 years in young athletes after ACL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 2018. DOI: 10.1007/s00167-018-5291-x

[75] Femoroacetabular impingement in elite ice hockey players. Knee Surgery, Sports Traumatology, Arthroscopy. 2013. DOI: 10.1007/s00167-013-2598-5

[76] Return to sports after arthroscopic Bankart repair in teenage athletes: a retrospective cohort study. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06145-y

[77] Sport-Specific Injury Pattern Recorded During Anterior Cruciate Ligament Reconstruction. The American Journal of Sports Medicine. 2013. DOI: 10.1177/0363546513501791

[78] GENDER DIFFERENCES IN REPORTED RECOVERY TIME FROM SPORTS-RELATED CONCUSSION IN DUAL GENDER SPORTS FROM 2012-2017. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120s00139

[79] Incidence of Second ACL Injuries 2 Years After Primary ACL Reconstruction and Return to Sport. The American Journal of Sports Medicine. 2014. DOI: 10.1177/0363546514530088

[80] Magnetic Resonance Imaging–Documented Chondral Injuries About the Knee in College Football Players: 3‐Year National Football League Combine Data. Arthroscopy. 2010. DOI: 10.1016/j.arthro.2010.01.025

[81] Do National Hockey League Injury Rates Increase During the Years Players Participate in the Winter Olympics?. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671251389108

[82] Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967119897247

[83] Chapter 26 Hip Rehabilitation. 2019.

[84] Relationship Between Arm Path, Ball Velocity, and Elbow Varus Torque in Professional Baseball Pitchers. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/23259671231202524

[85] Baseball Pitchers who Suffer Latissimus Dorsi and Teres Major Tendon Injuries Have a High Return to Play Rate After Either Operative or Nonoperative Treatment. Arthroscopy, Sports Medicine, and Rehabilitation. 2023. DOI: 10.1016/j.asmr.2023.100787

[86] Increasing pitch count is associated with increasing elbow flexion angle at ball release in youth baseball pitchers. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.05.050

[87] Changes in Youth Baseball Pitching Biomechanics: A 7-Year Longitudinal Study. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517732034

[88] Machine Learning and Statistical Prediction of Pitching Arm Kinetics. The American Journal of Sports Medicine. 2021. DOI: 10.1177/03635465211054506

[89] The Return‐to‐Sport Clearance Continuum Is a Novel Approach Toward Return to Sport and Performance for the Professional Athlete. Arthroscopy, Sports Medicine, and Rehabilitation. 2022. DOI: 10.1016/j.asmr.2021.10.026

[90] Season-Ending Shoulder Injuries in the National Collegiate Athletic Association: Data From the NCAA Injury Surveillance Program, 2009-2010 Through 2013-2014. The American Journal of Sports Medicine. 2018. DOI: 10.1177/0363546518773062

[91] The Prevalence of Spondylolysis in the Spanish Elite Athlete. The American Journal of Sports Medicine. 2000. DOI: 10.1177/03635465000280012101

[92] Long-Term Prognosis for Jumper's Knee in Male Athletes: Prospective Follow-up Study. The American Journal of Sports Medicine. 2002. DOI: 10.1177/03635465020300051001

[93] Progressive Elbow Magnetic Resonance Imaging Abnormalities in Little League Baseball Players Are Common: A 3-Year Longitudinal Evaluation. The American Journal of Sports Medicine. 2019. DOI: 10.1177/0363546519888647

[94] Effects of Prior Knee Surgery on Subsequent Injury, Imaging, and Surgery in NCAA Collegiate Athletes. The American Journal of Sports Medicine. 2014. DOI: 10.1177/0363546513519951

[95] The unstable os acromiale: a cause of pain in the young athlete. JSES International. 2020. DOI: 10.1016/j.jseint.2020.02.008

[96] Early sports specialisation and the incidence of lower extremity injuries in youth athletes: current concepts. Journal of ISAKOS. 2021. DOI: 10.1136/jisakos-2019-000288

[97] Asymptomatic elite young tennis players show lateral and ventral growth plate alterations of proximal humerus on MRI. Knee Surgery, Sports Traumatology, Arthroscopy. 2016. DOI: 10.1007/s00167-016-4024-2

[98] Treatment of Magnetic Resonance Imaging-Documented Isolated Grade III Lateral Collateral Ligament Injuries in National Football League Athletes. The American Journal of Sports Medicine. 2009. DOI: 10.1177/0363546509344075

[99] Intrinsic and Extrinsic Risk Factors for Anterior Cruciate Ligament Injury in Australian Footballers. The American Journal of Sports Medicine. 2001. DOI: 10.1177/03635465010290021301

[100] Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surgery, Sports Traumatology, Arthroscopy. 2004. DOI: 10.1007/s00167-004-0499-3

[101] The lateral femoral notch sign following ACL injury: frequency, morphology and relation to meniscal injury and sports activity. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-014-3022-5

[102] Return to Play after Anterior Cruciate Ligament Reconstruction in National Football League Athletes. The American Journal of Sports Medicine. 2010. DOI: 10.1177/0363546510372798

[103] Sport Specialization and Exposure in a Tertiary Concussion Program. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/2325967121s00537

[104] Assessment of Elbow Torque and Other Parameters During the Pitching Motion: Comparison of Fastball, Curveball, and Change‐up. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.09.045

[105] Effect of Anterior Cruciate Ligament Reconstruction and Meniscectomy on Length of Career in National Football League Athletes. The American Journal of Sports Medicine. 2009. DOI: 10.1177/0363546509349035

[106] The effects of exercise type and elbow angle on vertical ground reaction force and muscle activity during a push-up plus exercise. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0486-5

[107] Understanding the Disabled Throwing Shoulder Requires Updated Review of Anatomy, Mechanics, Pathomechanics, and Treatment. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2022. DOI: 10.1016/j.arthro.2022.02.024

[108] A Biomechanical Analysis of the Association Between Forearm Mechanics and the Elbow Varus Moment in Collegiate Baseball Pitchers. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517733471

[109] Correlation of Throwing Mechanics With Elbow Valgus Load in Adult Baseball Pitchers. The American Journal of Sports Medicine. 2009. DOI: 10.1177/0363546509336721

[110] Biomechanical Comparisons Among Fastball, Slider, Curveball, and Changeup Pitch Types and Between Balls and Strikes in Professional Baseball Pitchers. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517730052

[111] Role of Rotational Kinematics in Minimizing Elbow Varus Torques for Professional Versus High School Pitchers. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118760780

[112] Pitching Kinematics and Kinetics Related to the Elbow Joint Load in Young Female Baseball Players: A Comparison With Young Male Baseball Players. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671251343795

[113] Revision Ulnar Collateral Ligament Reconstruction Using a Suspension Button Fixation Technique. The American Journal of Sports Medicine. 2009. DOI: 10.1177/0363546509350109

[114] Increased Medial Elbow Torque Is Associated With Ball Velocity Rather Than a History of Medial Elbow Injuries in Youth Baseball Pitchers. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.07.016

[115] Return to Athletic Activity After Plate Fixation of Displaced Midshaft Clavicle Fractures. The American Journal of Sports Medicine. 2013. DOI: 10.1177/0363546513501494

[116] Kinetic chain contributions to elbow function and dysfunction in sports. Clinics in Sports Medicine. 2004. DOI: 10.1016/j.csm.2004.04.010

[117] Chronic Structural Adaptations of the Shoulder and Elbow Are Correlated in Professional Baseball Pitchers. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465251317509

[118] Return-to-Play Outcomes After Microscopic Lumbar Diskectomy in Professional Athletes. The American Journal of Sports Medicine. 2012. DOI: 10.1177/0363546512458570

[119] Boys demonstrate greater knee frontal moments than girls during the impact phase of cutting maneuvers, despite age‐related increases in girls. Knee Surgery, Sports Traumatology, Arthroscopy. 2023. DOI: 10.1007/s00167-023-07340-z

[120] Accelerated rehabilitation after arthroscopic Bankart repair in professional footballers. Shoulder & Elbow. 2016. DOI: 10.1177/1758573216647898

[121] Surgical treatment of distal hamstring tendon injuries yield a higher return‐to‐sports rate: A systematic review. Knee Surgery, Sports Traumatology, Arthroscopy. 2024. DOI: 10.1002/ksa.12075

[122] Hip Arthroscopy in athletes with Femoroacetabular Impingement: functional outcomes. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117s00022

[123] Return to sport after arthroscopic xenograft bone block associated with Bankart repair and subscapularis augmentation in competitive contact athletes with recurrent anterior shoulder instability. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.05.047

[124] Nonoperative treatment and return to play after complete proximal adductor avulsion in high-performance athletes. Knee Surgery, Sports Traumatology, Arthroscopy. 2015. DOI: 10.1007/s00167-015-3669-6