Kay M. Crossley

The study aimed to examine the association between knee surgery and infrapatellar fat pad volume in female and male runners, and the association between fat pad volume and patellofemoral‐related symptoms among runners with knee surgery. This study presents a secondary exploratory analysis of a prospective cohort study. Data from female and male runners with ( n = 104, 49% female) or without ( n = 99, 52% female) knee surgery were included. Fat pad volumes were measured from knee magnetic resonance images. Patellofemoral‐related symptoms were evaluated using the patellofemoral pain and osteoarthritis subscale of the Knee injury and Osteoarthritis Outcome Score. Linear regression models were used to assess the associations between prior knee surgery and fat pad volume in females and males, and zero‐inflated beta regression models were used to evaluate the associations between fat pad volume and patellofemoral‐related symptoms in the knee surgery group. All models were adjusted for age, body mass, and height. Females with prior knee surgery had a smaller fat pad volume (mean difference [95% CI]: −1.80 cm ³ [−3.02, −0.57], p = 0.004) than controls. However, this was not observed in males (0.30 cm ³ [−1.39, 2.00], p = 0.723). Among runners with prior knee surgery, fat pad volume was not associated with symptoms in either females (average marginal effects [95% CI]: −0.035 [−0.831, 83.10], p = 0.931) or males (0.255 [−0.233, 23.30], p = 0.306). Females, but not males, exhibit a smaller fat pad volume after knee surgery compared with no surgery controls. Among runners with a history of knee surgery, fat pad volume does not appear to be associated with patellofemoral‐related symptoms.

Chronic knee symptoms and early-onset osteoarthritis are common after anterior cruciate ligament reconstruction (ACLR). Evidence to inform management is needed. To evaluate whether physiotherapist-supervised exercise therapy with education is superior to a single education session and self-directed exercise resource for young adults with persistent knee problems after ACLR. Parallel-group randomized trial. (Australian New Zealand Clinical Trials Registry: ACTRN12620001164987). Community. 184 young adults (aged 18 to 40 years) with persistent knee problems 9 to 36 months after ACLR. A 4-month twice-weekly physiotherapist-supervised exercise therapy program with education (SUPER [SUpervised exercise-therapy and Patient Education Rehabilitation]; n = 92) and a single physiotherapist-delivered education session and self-directed exercise resource (control; n = 92). Primary outcome was 4-month change in the composite Knee injury and Osteoarthritis Outcome Score (KOOS₄; 0= worst, 100= best). Secondary outcomes included KOOS₄ at 12 months and thigh muscle strength, patient-perceived global rating of change, and cartilage thickness and composition on magnetic resonance imaging at 4 and 12 months. 184 participants were randomly assigned (mean age, 30 years [SD, 6]; 2.2 years [SD, 0.7] after ACLR); 178 (97%) and 174 (95%) completed 4-month and 12-month follow-up, respectively. At 4 months, KOOS₄ scores improved more in the SUPER group than in the control group (14.1 vs. 9.4; adjusted mean difference, 4.8 [95% CI, 1.4 to 8.2]). At 4 months, SUPER resulted in greater muscle strength gains and higher rates of success on global rating of change (for example, pain 73% vs. 40%). Between-group differences narrowed at 12 months as the control group continued to improve, whereas SUPER gains were sustained. There were no between-group differences seen in cartilage thickness or composition. Unblinded participants. For young adults with persistent knee problems after ACLR, physiotherapist-supervised exercise therapy with education improved patient-reported outcomes compared with a single education session and self-directed exercise resource, but these between-group differences may not be sustained over time. National Health and Medical Research Council.

Background: Little is known about the long-term health outcomes associated with sustained elite performance once female Olympians retire from their Olympic careers. Objective: The aim of this study was to determine and compare (1) musculoskeletal health, (2) general health and (3) current physical activity (PA) behaviours between a global sample of female retired Olympians and general population controls. Methods: A cross-sectional survey comprised four sections: (1) background information, (2) injury history, (3) current musculoskeletal health and (4) general health. A total of 1488 retired female Olympians and 998 female controls completed the survey. Poisson regression analysis was used to determine prevalence ratios (aPR) with 95% confidence intervals (CI) adjusted for age, body mass index (BMI) and/or previous significant injury or current persistent pain. Results: Adjusting for age, BMI and previous significant injury, more retired female Olympians reported stiffness, pain and/or osteoarthritis (OA) (aPR [95% CI]) in the cervical spine (stiffness 1.42 [1.08–1.86]; OA 1.85 [1.01–3.39]), lumbar spine (stiffness 1.41 [1.18–1.67], pain 1.41 [1.15–1.73]) and hip (OA 1.82 [1.08–3.06]) compared with controls. Stiffness, pain and OA at the knee were also higher for Olympians, but not when adjusting for prior injury. No differences were observed between groups for self-reported disease states, however the prevalence of most health conditions increased among Olympians following retirement, except for depression which decreased. Both groups rated their health-related quality of life (retired female Olympians: 88/100; Controls: 89/100) and mental health similarly, while the prevalence of participation in weekly sport (aPR: 0.75 [0.66–0.85]) and physical activity (aPR: 0.91 [0.87–0.95]) was slightly lower in retired Olympians when adjusted for age, BMI and current persistent musculoskeletal pain. Conclusions: Retired female Olympians report poorer musculoskeletal health than the general population, a difference only partly attributable to previous significant injury, which suggests elements of elite athletic exposure may underlie some of these outcomes. Primary and secondary prevention of shoulder, hip and knee injuries remains a priority with consideration to long-term outcomes. Future research should broaden our understanding of retired female athlete health by exploring the largely under-researched domains of cognitive, reproductive, breast and pelvic floor health.

This study explored the perspectives of elite athletes diagnosed with an injury requiring a minimum of 4 months of rehabilitation based on the health professional’s prognosis. Through a longitudinal phenomenological design, we captured perceptions and experiences of elite athletes from different sports, countries and injury types following major injury. Athletes were interviewed at different stages of the return to sport process (from early rehabilitation to return to performance), resulting in a total of 31 interviews analysed using longitudinal interpretative phenomenological analysis. Three overarching journey phases were identified. (1) The Rough Start was characterised by uncertainty about the future, loss of athletic identity, emotional distress and feelings of isolation as athletes adjusted to injury. (2) The Roller coaster rehab reflected emotional fluctuations, small achievements and setbacks, the influence of previous injury experiences, the importance of support systems and challenges related to communication with health professionals. (3) The Journey’s End involved athletes feeling like athletes again, experiencing a sense of accomplishment and reflecting on personal growth. During this phase, some athletes reassessed priorities or made decisions about career transitions. The final steps towards return to performance were often shaped by factors beyond athletes’ control, including team dynamics, competition opportunities and organisational decisions. Despite shared themes, athletes’ narratives showed substantial variability. This study provides in-depth insight into how athletes’ journeys are non-linear and highly individual. It highlights the importance of flexible, athlete-centred care that values communication, individual responses to injury and the wider sporting and career context, rather than relying solely on standardised protocols or physical criteria.

Context : Hip crepitus creates negative emotions and beliefs, leading to adaptations in sports and daily life activities. People with hip/groin pain present psychological responses to pain, and hip crepitus severity may amplify those features. We aimed to explore associations between self-reported hip crepitus severity and pain, quality of life, and psychological features at baseline and 2-year follow-up in football players with hip/groin pain. Design : Longitudinal. Methods : We recruited 184 football players with hip/groin pain (20% females, mean age [SD] = 27.6 [0.4]). Self-reported crepitus severity was assessed using a single item of the International Hip Outcome Tool-33. Pain severity was assessed using a Numeric Pain Rating Scale describing average pain playing football and average pain in the last month. Quality of life was assessed using the Copenhagen Hip and Groin Outcome Score subscale. Psychological features included standardized measures of kinesiophobia and pain catastrophizing. We assessed associations between crepitus severity and these outcomes using linear regression. Results : At baseline, greater (worse) hip crepitus severity was associated with worse average pain in the last month ( β = −0.02), quality of life ( β = 0.16), and kinesiophobia ( β = −0.05). We found sex interactions for pain catastrophizing and average pain playing football, with stronger associations in females ( β = −0.19 and β = −0.03) than males ( β = −0.09 and β = −0.01). Hip crepitus severity at baseline was not associated with changes in pain, quality of life, or psychological features over 2 years. Conclusion : Worse hip crepitus severity was cross-sectionally associated with worse pain, quality of life, and psychosocial features in football players with hip/groin pain, but not with the progression of these outcomes over 2 years. Females had a stronger association between hip crepitus and pain catastrophizing and average pain playing football than males at baseline.

Objective Labral tears are common in young adults participating in high-impact physical activity. No longitudinal studies have investigated whether labral tears expedite cartilage loss. This longitudinal study investigated the association between labral tears and cartilage loss in young adults participating in high-impact physical activity. Methods Study participants were high-impact athletes (soccer or Australian football) with and without hip and/or groin pain from the femoroacetabular impingement and hip osteoarthritis cohort study who underwent unenhanced 3T MRI at baseline and after 2–3 years. Labral tears and cartilage defects were scored semi-quantitatively. At baseline, labral tear presence (grade ≥2), subregion, number of subregions affected by labral tear, maximal labral score, labral sum score and presence of paralabral cysts were determined. A cartilage sum change score (difference between baseline and follow-up) was calculated for each hip (0–20). Negative binomial regression models were used to estimate if baseline labral tears were associated with cartilage loss, adjusting for sex, age, body mass index, alpha angle and baseline cartilage sum score. Results 173 (343 hips) participants (82% with hip and/or groin pain; 22% women) with a median age of 26 years were included. The median International Hip Outcome Tool-33 total score was 69 at baseline. Follow-up MRIs were collected at a median of 2.1 years after baseline. 150 (87%) participants were still participating in high-impact physical activity at follow-up. Weak-to-moderate strength associations were identified between cartilage sum change score and baseline anterior labral tears (adjusted incidence rate ratio (a)IRR 1.46; 95% CI 1.01 to 2.09), paralabral cysts (aIRR 1.38; 95% CI 1.02 to 1.86) and labral sum score (aIRR 1.05; 95% CI 1.00 to 1.09). Conclusion Our findings suggest that acetabular labral tears contribute to cartilage loss in young adult athletes; however, the associations observed were modest, suggesting that additional factors contribute to cartilage loss in this population. Further research is required to inform preventative strategies aimed at reducing cartilage loss in athletes with labral tears.

Understanding factors associated with early hip osteoarthritis (OA) in young active adults may facilitate hip OA prevention. We investigated the cross‐sectional association between hip contact force (HCF) during walking and cartilage defect severity, accounting for cam morphology size (alpha angle), hip pain severity, sex, age, and walking speed, in football players with hip/groin pain. One hundred and twenty‐one football players (18–50 years; 26 women) with > 6‐month hip/groin pain and no radiographic OA underwent MRI and a Dunn 45° radiograph. Outcome: Scoring Hip Osteoarthritis with MRI (SHOMRI) score for cartilage defect severity (0–20), categorized into three SHOMRI groups: (a) SHOMRI = 0; (b) SHOMRI = 1–3; and (c) SHOMRI = 4+. Movement and ground force data were captured whilst participants walked at their self‐selected pace. Musculoskeletal modeling was used to calculate HCF for one stride cycle. The exposure variable was HCF impulse (body weight times seconds [BW.s]). Differences in HCF impulse based on SHOMRI group (for the most symptomatic hip) were assessed using linear models, controlling for alpha angle, sex, age, walking speed, hip pain, and contralateral hip pain status. Resultant HCF impulse was significantly higher for participants in the 0 versus 4+ SHOMRI group (mean difference; 95%CI: 0.142BW.s; 0.028–0.256 for swing and 0.106BW.s; 0.029–0.184 for stance) and 0 versus 1–3 SHOMRI group (0.071 BW.s; 0.016–0.125 for swing). Participants with more severe cartilage defects walked with lower hip joint loading, and other variables (e.g., alpha angle size, hip pain severity, age) contributed little to this relationship. Hip joint under‐loading could be a possible target for hip OA prevention.

Anterior cruciate ligament (ACL) rupture is a serious sporting injury associated with impaired performance, high recurrence rates, early-onset knee osteoarthritis and substantial health and economic burden. In Australia, ACL injury incidence has increased over the past two decades, with particularly high rates observed among female and adolescent athletes participating in cutting and landing sports. Neuromuscular and structured warm-up programs can reduce ACL injury risk; however, implementation and adherence remain inconsistent, and evidence for effectiveness in males, elite athletes and several high-risk sports is unclear. Practitioners, therefore, require clear, evidence-based guidance to prescribe effective prevention strategies across diverse populations. This position statement provides contemporary, evidence-informed recommendations to guide exercise prescription for ACL injury prevention by (1) critically evaluating the effect of existing exercise interventions on ACL injury incidence, and (2) synthesising evidence on intrinsic risk factors and mechanistic pathways for non-contact ACL injury to inform targeted training strategies. Two systematic literature searches were conducted in Scopus, Embase and PubMed. The first identified randomised and non-randomised controlled trials and cohort studies evaluating the effect of exercise-based interventions on ACL injury incidence. The second identified prospective studies examining intrinsic risk factors for non-contact ACL injury. Evidence on ACL injury aetiology was synthesised by integrating injury risk factors, video analyses of injury events, in vivo and in vitro laboratory studies and in silico biomechanical modelling. We propose a tiered framework for exercise prescription. Tier 1 strategies emphasise population-level neuromuscular and structured warm-up programs, which meta-analyses indicate can reduce ACL injury risk by approximately 60% in adolescent female soccer, basketball and handball players. Effective programs typically combine plyometric, strength, balance/proprioception, mobility and agility exercises performed for 10–30 min, 2–3 times per week. Tier 2 strategies target specific neuromuscular deficits or high-risk movement patterns, including low knee flexion, dynamic knee valgus, lateral trunk flexion and excessive step width. Interventions may include plyometric and resistance exercises, motor control drills and neurocognitive challenges to increase transfer to game scenarios; however, direct evidence linking Tier 2 strategies to reduced injury incidence remains limited. This position statement provides an evidence-based framework to support the design and practical implementation of effective ACL injury prevention strategies in sport.

Objectives Evaluate the effect of supported implementation on a co-created injury prevention programme (Prep-to-Play) use and injury incidence and evaluate the dose response relationship between adherence and injury incidence. Methods In this hybrid implementation-effectiveness stepped wedge cluster randomised trial, 165 women’s/girls’ Australian Football teams (2481 players) were randomly allocated to transition from unsupported to supported implementation at one of five time points during 2021/2022. Supported implementation included in-person workshops and support visits for coaches/team leaders. Unsupported implementation was access to online resources. Prep-to-Play includes warm-up, contact and strength activities. Primary (Prep-to-Play use) and secondary (concussion, anterior cruciate ligament (ACL)) outcomes were reported weekly. Weekly Prep-to-Play use (yes/no) was defined as using ≥75% of programme elements, ≥two-thirds of sessions each week. Analyses compared outcomes between supported and unsupported phases, adjusted for clustering, period, age group, competition level and region. Results Average weekly Prep-to-Play use by teams was 13.1% (95% CI 11.5% to 14.9%) in the unsupported and 29.7% (95% CI 27.6% to 31.9%) in supported phase (OR 3.7 95% CI 2.4 to 5.7). The concussion and ACL injury incidence (per 1000 game hours) was 6.80 (95% CI 5.75 to 8.05) and 1.36 (95% CI 0.98 to 1.89) in unsupported, and 3.50 (95% CI 2.72 to 4.52) and 0.69 (95% CI 0.44 to 1.15) in supported, respectively, but the effect of supported implementation on injury incidence was unclear (concussion: incidence rate ratios (IRR) 1.36; 95% CI 0.74 to 2.49; ACL: IRR 2.27 (0.56 to 9.12). Higher Prep-to-Play adherence was associated with fewer total injuries (IRR: 0.95 95% CI 0.92 to 0.99). Conclusions Supported implementation via in-person workshops and support visits was associated with greater Prep-to-Play use compared with unsupported implementation, and greater adherence was associated with fewer injuries. Trial registration number NCT04856241.