Hsu, Kai‐Lan

Abstract Objective Sleeper stretching (SS) and cross‐body stretching (CS) are common nonsurgical interventions for the management of glenohumeral internal rotation deficit (GIRD) in overhead athletes such as baseball and volleyball players. However, the effectiveness of these stretching interventions in enhancing the range of motion (ROM) of shoulder internal rotation (IR) in overhead athletes with GIRD remains a subject of uncertainty. This systematic review and meta‐analysis aim to critically assess the efficacy of SS and CS in the ROM of the IR among overhead athletes with GIRD, thereby providing evidence‐based recommendations for their use. Literature Survey A comprehensive search of MEDLINE, Embase, and Scopus databases up to November 2024 was conducted to identify randomized controlled trials investigating the influence of SS and CS on the ROM of shoulder IR in overhead athletes with GIRD. Methodology Data including study characteristics and outcomes were extracted. Risk of bias assessment and random‐effects model meta‐analysis were performed. Synthesis Six eligible studies involving 255 athletes with GIRD were included. The meta‐analysis demonstrated statistically significant differences between stretching and control groups in terms of enhancing the ROM of IR (mean difference [MD], 7°; 95% confidence interval [CI], 1°–13°; p = .02) and horizontal adduction (HAD) ([MD], 6°; [CI], 1°–11°; p = .03). Conclusion SS or combination of SS and CS interventions significantly enhanced the ROM of IR compared to the control group in overhead athletes diagnosed with GIRD. Furthermore, the review confirmed that SS alone also markedly enhances the ROM of HAD. These findings highlight the potential benefits of SS and CS in managing GIRD and suggest a need for further research to optimize these interventions for broader application in overhead athletes.

Abstract Purpose This systematic review and meta‐analysis aimed to (1) determine the proportion of patients who underwent anterior shoulder instability surgery and did not return to sports for psychological reasons and (2) estimate differences in psychological readiness scores between patients who did and did not return to sports. Methods The EBSCOhost/SPORTDiscus, PubMed/Medline, Scopus, EMBASE and Cochrane Library databases were searched for relevant studies. The data synthesis included the proportion of patients who did not return to sports for psychological reasons and the mean differences in the psychological readiness of athletes who returned and those who did not return to sports. Non‐binomial data were analysed using the inverse‐variance approach and expressed as the mean difference with 95% confidence intervals. Results The search yielded 700 records, of which 13 (1093 patients) were included. Fourteen psychological factors were identified as potential causes for not returning to sports. The rates of return to sports at any level or to the preinjury level were 79.3% and 61.9%, respectively. A total of 55.9% of the patients cited psychological factors as the primary reason for not returning to sports. The pooled estimate showed that patients who returned to sports had a significantly higher Shoulder Instability‐Return to Sport After Injury score ( P < 0.00001) than those who did not, with a mean difference of 30.24 (95% CI 24.95–35.53; I 2 = 0%; n.s.). Conclusions Psychological factors have a substantial impact on the rate of return to sports after anterior shoulder instability surgery. Patients who returned to sports had significantly higher psychological readiness than those who did not return to sports. Based on these results, healthcare professionals should include psychological and functional measurements when assessing athletes’ readiness to return to sports. Level of evidence Level IV.

AbstractPurposeThis study aimed to comprehensively review the existing evidence concerning surgical treatment of inferior pole fractures of the patella and to report the outcomes and complications of different fixation techniques.MethodThis systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Searches of PubMed, Scopus, and Web of Science were conducted in March 2023. Studies were screened against predecided inclusion and exclusion criteria. The extracted data included fracture characteristics, surgical techniques, and radiographic and functional outcomes. The Methodological Index for Non‐Randomized Studies (MINORS) quality assessment tool was used to assess the eligible literature. The primary outcome was postoperative range of motion of different surgical methods, and the secondary outcomes were other clinical results and complications.ResultsA total of 42 studies satisfied all the inclusion criteria and were deemed suitable for review. Fourteen case–control studies and 28 case series were selected, for a total of 1382 patients with a mean age of 51.0 years (range = 11–90). The follow‐up period ranged from 6 to 300 months. The surgical techniques were categorized based on the device used as follows: (1) rigid fixation device; (2) tensile fixation device; (3) mixed device; and (4) extra‐patella device.ConclusionRegarding the outcomes following surgical treatment of inferior pole fractures of the patella, the postoperative range of motion (ROM) of each technique ranged from 120° to 135°, with the exception of that involving the patellotibial wire which had poorer outcomes. The lowest functional score was also found in those using the patellotibial wire. Complications after surgery are rare, but approximately half of the patients required additional surgery for implant removal, particularly those whose initial surgery involved rigid fixation devices. It's worth noting that bony fragment excision is no longer recommended, and the combined use of multiple surgical devices is now more common.