Fabián Patricio Miranda Yáñez

Sports and exercise-related injuries represent an important challenge for public health because they may reduce physical activity participation, impair functional capacity, and increase healthcare utilization. This study analyzed the effectiveness of evidence-based sports injury-prevention programs and their potential integration into health-promotion policies for the general population. A structured literature review based on the Scientific Method was conducted using systematic reviews, meta-analyses, randomized controlled trials, consensus statements, and international guidelines. The analysis focused on strength training, neuromuscular exercises, balance and proprioception, structured warm-up programs, training-load management, adherence, implementation, and policy-level strategies. The reviewed evidence showed consistent reductions in injury occurrence with structured exercise-based interventions, with strength training, proprioceptive training, neuromuscular programs, and preventive warm-ups demonstrating particularly favorable outcomes. Higher adherence was associated with greater preventive effectiveness, emphasizing the importance of consistent implementation. Most of the available evidence was concentrated at the individual level, while community, organizational, and policy interventions were less frequently represented. The findings support a multicomponent and multilevel approach in which physical preparation is combined with education, progressive workload management, organizational support, safe environments, and public health strategies. Integrating these measures into schools, fitness centers, recreational sports programs, healthcare services, and community settings may contribute to reducing preventable injuries without limiting participation in physical activity. Sports injury prevention should therefore be incorporated into broader health-promotion policies aimed at creating safer, sustainable, and equitable opportunities for active living.

Arrhythmias and sudden cardiac death represent major challenges in sports cardiology because they may occur in apparently healthy athletes and may be related to structural heart disease, inherited channelopathies, coronary abnormalities, myocarditis, or other arrhythmogenic substrates. This study analyzed the principal factors associated with sudden cardiac death in athletes, with emphasis on cardiovascular preparticipation evaluation, electrocardiographic interpretation, characterization of ventricular arrhythmias, and perioperative cardiovascular management. An integrative review and analytical synthesis of clinical guidelines, consensus statements, epidemiological studies, systematic reviews, and relevant observational investigations was performed using evidence from recognized scientific databases and international cardiovascular societies. The findings demonstrated that sudden cardiac death is uncommon overall but is heterogeneously distributed, with higher incidence reported in specific groups such as male athletes, Black athletes, and Division I male basketball players. Hypertrophic cardiomyopathy, congenital coronary artery anomalies, myocarditis, arrhythmogenic cardiomyopathy, and inherited electrical disorders were identified among the principal underlying conditions. Athlete-specific electrocardiographic criteria reduced abnormal classifications while preserving the detection of clinically significant cardiovascular disease. The analysis of ventricular ectopy showed that morphology, complexity, exercise response, symptoms, and the presence of structural abnormalities are more clinically informative than arrhythmic burden alone. In the perioperative setting, high functional capacity does not eliminate cardiovascular risk, particularly in athletes with known or suspected arrhythmogenic substrates. Electrolyte disturbances, autonomic fluctuations, anesthetic agents, hypoxemia, hemodynamic changes, and surgical stress may facilitate perioperative rhythm disturbances. The evidence supports an integrated and individualized strategy combining preparticipation screening, targeted diagnostic testing, arrhythmic risk stratification, shared decision-making, and perioperative planning. This approach may improve the identification of high-risk athletes while avoiding unnecessary restrictions and promoting safer participation in sport and surgical care.

Occult osteochondral lesions represent an important challenge in sports medicine because they may remain undetected during initial assessment despite persistent pain, swelling, mechanical symptoms, and functional limitation. This study analyzed the role of diagnostic imaging, clinical and structural evolution, and return-to-sport criteria in athletes with osteochondral injuries, with particular emphasis on the knee and ankle. An integrative descriptive and analytical review was conducted using the Scientific Method, incorporating evidence related to magnetic resonance imaging, computed tomography, CT arthrography, conservative management, surgical treatment, rehabilitation, and athletic recovery. The findings demonstrated that conventional radiography has limited sensitivity for early osteochondral abnormalities, whereas magnetic resonance imaging provides superior visualization of cartilage integrity, bone marrow edema, subchondral changes, and lesion stability. Computed tomography and CT arthrography offer complementary value for defining osseous architecture and selected cartilage-surface abnormalities. Clinical improvement and radiological recovery were not consistently parallel, indicating that symptomatic improvement does not necessarily imply complete structural restoration. Surgical procedures such as bone marrow stimulation, fixation, osteochondral transplantation, and cartilage restoration showed favorable clinical and return-to-sport outcomes in appropriately selected patients, although return to the pre-injury level was consistently lower than return to sport at any level. The reviewed literature also revealed substantial heterogeneity in rehabilitation protocols and a predominant reliance on time-based criteria for sports clearance. Overall, the evidence supports an individualized and multidimensional return-to-sport approach integrating symptoms, range of motion, muscle strength, neuromuscular control, tolerance to loading, sport-specific performance, psychological readiness, and imaging follow-up when clinically indicated. Early diagnosis and criterion-based rehabilitation may contribute to safer athletic reintegration and improved long-term preservation of joint function.

Muscle and tendon injuries remain among the most common causes of functional impairment and time-loss in elite athletes, representing a significant challenge for reconstructive surgery, sports medicine, and rehabilitation. Conventional treatment approaches frequently restore anatomical continuity but may not completely reproduce the biological and biomechanical properties of healthy tissue, increasing the risk of delayed recovery and recurrent injury. In recent years, biological augmentation has emerged as a promising strategy to enhance tissue regeneration through modulation of inflammation, stimulation of angiogenesis, promotion of extracellular matrix remodeling, and improvement of collagen organization. This narrative review critically examined current scientific evidence regarding the biological basis, clinical applications, and therapeutic potential of platelet-rich plasma, bone marrow aspirate concentrate, mesenchymal stromal cells, extracellular vesicles, exosomes, biomaterials, and tissue-engineered constructs for the management of muscle and tendon injuries in elite athletes. Current evidence suggests that platelet-rich plasma remains the most extensively investigated biological intervention, whereas cell-based therapies, biomaterials, and exosome-derived approaches continue to demonstrate considerable regenerative potential despite requiring further clinical validation. The findings also emphasize that successful recovery depends not only on biological augmentation but also on accurate diagnosis, individualized patient selection, technically sound reconstructive procedures, structured rehabilitation, progressive mechanical loading, and multidisciplinary clinical management. Although regenerative medicine continues to evolve rapidly, methodological heterogeneity among available studies highlights the need for standardized treatment protocols and large multicenter clinical investigations. Overall, biological augmentation represents a valuable adjunct to contemporary reconstructive strategies, offering new opportunities to improve tissue healing, functional recovery, and safe return to competitive sport in elite athletes.

Fragility fractures have become one of the most significant health challenges associated with global population aging, generating substantial consequences for functional independence, healthcare systems, and quality of life. This review aimed to analyze the current scientific evidence regarding the epidemiology, pathophysiology, risk factors, modern orthogeriatric management, and functional recovery of older adults sustaining fragility fractures. A structured literature review was conducted using international scientific databases and evidence-based clinical guidelines published by recognized organizations. The available evidence demonstrates that fragility fractures are multifactorial conditions resulting from the interaction of osteoporosis, sarcopenia, frailty syndrome, multimorbidity, nutritional deficits, and age-related physiological decline. Contemporary orthogeriatric care, based on multidisciplinary collaboration, Comprehensive Geriatric Assessment, timely surgical management, individualized rehabilitation, nutritional optimization, osteoporosis treatment, and secondary fracture prevention, consistently improves mobility, functional independence, postoperative outcomes, and long-term quality of life. Early rehabilitation and coordinated follow-up through structured fracture prevention programs were also associated with lower complication rates and reduced risk of recurrent fractures. Furthermore, the findings emphasize the growing importance of integrating orthopedic surgery, geriatrics, rehabilitation medicine, nutrition, and preventive care into patient-centered management strategies. As demographic aging continues to accelerate worldwide, particularly in Latin America, strengthening orthogeriatric services and implementing evidence-based multidisciplinary models represent essential strategies for preserving autonomy, reducing disability, and improving long-term clinical outcomes among older adults with fragility fractures.

Traumatic brain injury (TBI) remains one of the leading causes of mortality and long-term neurological disability worldwide, representing a major challenge for emergency medicine, neurosurgery, radiology, and neurocritical care. In recent years, substantial advances have transformed traditional approaches to TBI management through the incorporation of multimodal neuromonitoring systems, advanced neuroimaging technologies, artificial intelligence, and personalized therapeutic strategies. This review examines current innovations in traumatic brain injury management, focusing on intracranial pressure monitoring, brain tissue oxygen monitoring, cerebral microdialysis, advanced magnetic resonance imaging techniques, machine learning applications, and contemporary neurosurgical interventions. Scientific evidence from international studies demonstrates that multimodal monitoring provides a more comprehensive assessment of cerebral physiology by integrating information related to perfusion, oxygenation, metabolism, and neurological function, facilitating earlier identification of secondary brain injury and supporting individualized treatment decisions. Likewise, advanced neuroimaging modalities such as diffusion tensor imaging, susceptibility-weighted imaging, perfusion imaging, and functional magnetic resonance imaging have improved diagnostic precision and prognostic evaluation. Artificial intelligence has emerged as a promising tool for data integration, predictive analytics, lesion characterization, and clinical decision support. Collectively, these innovations are contributing to the evolution of neurocritical care toward precision medicine models that prioritize personalized monitoring and targeted therapeutic interventions. Although challenges related to accessibility, implementation, infrastructure, and training remain, particularly in low- and middle-income countries, the available evidence suggests that the integration of advanced monitoring technologies and data-driven clinical strategies may significantly improve neurological outcomes, reduce secondary injury, and enhance quality of life among patients affected by traumatic brain injury. Continued research, multidisciplinary collaboration, and equitable adoption of emerging technologies will be essential for advancing the future of neurotrauma care worldwide.

Modern warfare has generated increasingly complex patterns of injury characterized by massive hemorrhage, traumatic brain injury, blast-related trauma, vascular damage, and multisystem injuries, creating significant challenges for military and civilian healthcare systems. Continuous advances in tactical medicine, combat casualty care, neurocritical care, radiological imaging, and damage control strategies have substantially improved the management of these injuries and reduced preventable mortality in combat environments. This review analyzes current innovations in war trauma management, emphasizing developments in hemorrhage control, traumatic brain injury management, advanced radiological technologies, damage control surgery, damage control resuscitation, and multidisciplinary trauma systems. A structured narrative review was conducted using the Scientific Method and PRISMA-based review principles. Scientific evidence was identified through PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect, SpringerLink, Wiley Online Library, Cochrane Library, and Google Scholar, including peer-reviewed articles, clinical guidelines, systematic reviews, meta-analyses, and consensus statements published between 2005 and 2025. The available evidence demonstrates that Tactical Combat Casualty Care protocols, modern tourniquet systems, hemostatic dressings, balanced transfusion strategies, advanced neurocritical care, and innovative imaging techniques have significantly improved survival, neurological preservation, diagnostic accuracy, and long-term functional recovery among combat casualties. Furthermore, multidisciplinary trauma systems integrating tactical medicine, surgery, radiology, intensive care, and rehabilitation have strengthened continuity of care and enhanced patient outcomes throughout the recovery process. These advances have also influenced civilian trauma systems by improving emergency preparedness, disaster response, and management of severe traumatic injuries. Although important progress has been achieved, continued research remains necessary to optimize neuroprotective therapies, expand access to advanced technologies, improve rehabilitation strategies, and address the evolving challenges associated with modern warfare. Contemporary war trauma management has become a highly specialized, multidisciplinary, and evidence-based field whose innovations continue to shape the future of military and civilian trauma care worldwide.