Oslo Sports Trauma Research Center

Female, woman and/or girl athletes’ sport participation rates are rising and associated with high injury rates and burden. Using best-practice consensus methodology, we developed recommendations to guide injury prevention for female/woman/girl athletes. The Female/woman/girl Athlete Injury pRevention (FAIR) International Olympic Committee Consensus meeting was held from 31 March to 2 April 2025 (Lausanne, Switzerland).The FAIR Consensus followed an eight-step hybrid method. 109 authors from six continents conducted: (1) systematic reviews synthesising evidence on injury prevention strategies and modifiable risk factors for lower-extremity and upper-extremity injuries, concussions and spine/chest/abdominal/pelvic injuries/pain, (2) a scoping review synthesising dissemination and implementation (D&I) approaches; and (3) a concept mapping project generating knowledge on gender/sex-related factors for injury prevention. These projects underpinned draft recommendations subsequently voted on by a steering committee (n=24) and an external advisory committee chair over two anonymous survey rounds. Recommendations, Round 1 voting results and suggestions/dissenting comments were discussed between Round 1 and 2 voting. Consensus was defined as ‘critical to include’ (≥70% scored recommendation as 7–9 (9-point Likert scale, 1=not important; 9=critically important) AND ≤15% scored recommendation as 1–3).The 56 FAIR recommendations address: primary injury prevention (n=16) (policy/rules/laws=6; personal protective equipment=8; training=2); secondary injury prevention (n=4); modifiable risk factors (n=12); approaches to D&I (n=14); and promoting gender/sex-supportive environments (n=10).The FAIR Consensus informs evidence-based best practices and policy for injury prevention, approaches to implementation and creation of supportive environments for female/woman/girl athletes. Every person at all levels of sport can, and should, take responsibility for actions that positively influence female/woman/girl athlete health and safety.

PurposeTo compare 5‐year patient‐reported outcomes between hamstring tendon (HT) and bone–patellar tendon–bone (BPTB) autografts in primary anterior cruciate ligament reconstruction (ACLR), with particular focus on kneeling difficulties, extension deficits, and other functional limitations that have not been examined in long‐term follow‐up studies.MethodsThis retrospective analysis of prospectively collected data from the Norwegian Knee Ligament Register included 10,329 patients who underwent primary ACLR between 2004 and 2017 using either HT (n = 6650) or BPTB (n = 3679) autografts with 5‐year follow‐up. Primary outcomes were assessed using specific KOOS questions: P1 (knee pain frequency), S4 (knee extension ability), and SP5 (kneeling difficulty). Secondary outcomes included achieving Patient‐Acceptable Symptom State (PASS) thresholds for KOOS Sport/Recreation ( ≥ 75.0) and Quality of Life ( ≥ 62.5) subscales. Multivariable logistic regression analyses were performed to identify factors associated with treatment success or failure, adjusting for age, sex, activity level, cartilage injury, meniscal injury, and time from injury to surgery.ResultsAmong 10,329 patients available for evaluation from 19,564 eligible procedures (53% follow‐up response rate), HT grafts demonstrated a significantly reduced risk of kneeling difficulties (SP5) at 5‐year follow‐up compared to BPTB grafts (OR 0.57, 95% CI 0.51–0.62, p < 0.001). HT recipients had higher odds of achieving PASS for the Sport/Recreation subscale (OR 1.29, 95% CI 1.19–1.41, p < 0.001), but showed no difference in achieving PASS for Quality of Life. Risk factors for worse outcomes included female sex, cartilage injury, delayed surgery ( > 12 months), and participation in pivoting sports at injury.ConclusionsThis represents the first 5‐year comparative study examining graft‐specific differences in kneeling difficulties and extension deficits following ACLR. HT autografts significantly reduced the risk of kneeling problems and improved KOOS Sport/Recreation outcomes compared to BPTB grafts, while showing comparable results for pain and extension. These findings provide evidence for personalised discussions about graft selection.Level of EvidenceLevel III.

PurposeTo determine the incidence and treatment strategy for patellar instability in the Norwegian healthcare system.MethodsClinicians from all regional health regions were invited to contribute to the development of a cross‐sectional survey of the current national clinical practices for managing this patient group. A tailored questionnaire was developed to determine how many hospitals in Norway performed patellar stabilization surgery and which surgical procedures and postoperative routines were used. Specifically, the following variables were included: number of procedures performed in 2023, types of procedures, treatment of children, choice of graft for primary MPFL reconstruction, routine use of orthoses and postoperative restrictions.ResultsA survey was conducted among 68 hospitals, of which 35 reported performing patellar stabilisation procedures. The total number of procedures recorded was 532, yielding an incidence rate of 9.6 per 100,000 people. The number of procedures varied significantly among hospitals, with most performing between five and 20. All hospitals conducted medial patellofemoral ligament reconstruction, while 28 included bony procedures, and only seven performed derotational osteotomies. The preferred graft was gracilis (89%), and the most common fixation method on the femur was intrerference screw (60%). Postoperatively, only 20% of hospitals routinely recommended orthoses, primarily after tibial tuberosity osteotomy (86%). Restrictions on knee flexion were advised by 86% of respondents for up to eight weeks, and weight‐bearing restrictions were recommended by all after tibial tuberosity osteotomy.ConclusionsThis study offers an overview of patellar instability incidence and treatment in Norway, revealing significant variability in surgeries, procedures, restrictions, and follow‐up practices. This underscores the need for standardized guidelines and a national registry to improve patient outcomes and care quality. Future research should focus on evaluating long‐term outcomes of various surgical approaches and protocols to inform best practices.Level of EvidenceLevel III.

To describe the proposed biomedical effect mechanisms in research on exercise-based injury prevention programmes in football (soccer) and handball. Scoping review of randomised controlled trials (RCT), cohort studies and case studies. MEDLINE via PubMed, SPORTDiscus and Web of Science databases were searched from 2000 to 2024. Studies were included if they described exercise-based injury prevention programmes in football (soccer) or handball and provided a biomedical rationale or proposition of effect mechanisms. Peer-reviewed studies of all ages and both sexes at elite, subelite or amateur level were eligible. We included 104 studies (78 RCTs, 25 cohort studies, 1 case study) with sample sizes ranging from 10 to 4556 participants. Most studies (83%) were published after 2010, and interventions were reported to have an effect in 82% of the studies. Four main themes emerged describing the proposed effect mechanisms: neuromuscular control (47%), strength (39%), range of motion (11%) and physical fitness (3%). Definitions of key terms related to the intervention were provided in only 19% of studies, measurements of specific biomedical effect mechanisms were conducted in just 59% of studies. Neuromuscular control and strength were the predominant proposed effect mechanisms for injury prevention programmes in football and handball. To better establish effect mechanisms of exercise-based interventions, future research should consistently define key terms related to the interventions and strive to identify and test causal mechanisms to optimise injury prevention programmes.

Examine potentially modifiable risk factors (MRFs) for female/woman/girl athletes' lower-extremity injuries. Systematic review with meta- or semiquantitative analyses and Grading of Recommendations, Assessment, Development and Evaluation. MEDLINE, CINAHL, APA PsycINFO, Cochrane Systematic Review Database, CENTRAL, SPORTDiscus, EMBASE, ERIC searched 30 October or 23 November 2023. Primary data studies with comparison group(s) assessing the association of MRFs for sport-related lower-extremity injury(s) with ≥1 female/woman/girl per study group. Across 195 studies (n=115; 58.9% female/woman/girl-specific estimates) including 1 525 662 participants (2.4% females/women/girls), eight injury outcomes were assessed (n=75 general lower-extremity, n=3 groin, n=6 hip, n=17 thigh, n=88 knee, n=17 lower-leg, n=27 ankle, n=9 foot). Sixty-six MRF categories were identified. Substantial heterogeneity in MRFs and injury outcomes exists, with high risk of bias present in 37.4% of studies. Considering female/woman/girl specific estimates, we performed meta-analyses for 10 MRFs (body mass, x (BMI), weekly training distance, muscle strength, artificial turf, off-season plyometric training, readiness to return-to-sport, single-leg hop asymmetry, vertical drop jump peak knee flexion angle and ground reaction force) and semiquantitative analyses for 26 MRFs for a variety of injuries. Meta-analyses suggest no association between any lower-extremity strength outcome (g=0.01, 95% CI -0.11 to 0.14; I2=37.3%; very low certainty evidence) or artificial turf (Incidence Rate Ratio=0.97, 95% CI 0.88 to 1.07; I2=2.4%; low certainty evidence) and various lower-extremity injuries. Higher body mass (g=0.19, 95% CI 0.00 to 0.38; I2=71.7%) and/or BMI (g=0.22, 95% CI 0.09 to 0.36; I2=37.0%) are associated with several lower-extremity injuries (very low certainty evidence). This review synthesises a large body of exploratory research, exposes important knowledge gaps and provides a foundation for understanding MRFs for female/woman/girl athlete lower-extremity injuries. PROSPERO CRD42024486715.

To enhance performance, increase resilience and prevent injuries, training and testing (T&T) are the most important strategies for preparing athletes for the demands of their sport. However, for competitive snow sports such as alpine skiing, freestyle skiing and snowboarding, there is little evidence and a lack of international harmonisation of current best practices. This consensus statement, commissioned by the International Ski and Snowboard Federation (FIS), aims to provide recommendations for the physical and psychological T&T of competitive alpine and freestyle skiers and snowboarders within National Ski and Snowboard Associations. A diverse international consensus panel was selected to represent the subject matter regarding gender, nationality, expertise/background, level of competition and skiing and snowboarding discipline. Researchers, officials, physicians, physiotherapists, coaches and former athletes with extensive experience in the field were among the experts. However, the panel had a limited gender balance (seven women and 13 men) and was over-represented by European members (65%) and North American members (20%), whereas there was limited representation of perspectives from South American (5%), Australasian (5%) and African (5%) experts and a lack of experts from Asia. In the first step, the panel established an overarching structure of topics and questions to be addressed by the consensus statement. Following the RAND-UCLA appropriateness method, the consensus process subsequently included panellist ratings, discussions and revisions informed by statements derived from the literature or expert/panellist opinions. These two outcomes served as the basis for manuscript writing, which was finalised through two iterative rounds of manuscript feedback and revision. This consensus statement aims to help athletes, coaches and medical staff of international and national federations plan and implement effective T&T activities for competitive alpine and freestyle skiers and snowboarders.

ABSTRACTSports have been identified as an important contributor to social sustainability, and the benefits for health, well‐being, and social learning in young people are well evidenced. Youth elite sports, however, have been criticized as being unsustainable. Following calls for a more socially sustainable development of youth elite sports, research on the topic has increased. However, studies vary in disciplinary origin, concepts, content, and methodology. The aim of this systematic scoping review is to identify and synthesize the current disciplinary research knowledge. Five disciplinary databases were searched. Based on six eligibility criteria and a double‐blind review process, a total of 99 articles were selected. Findings were first charted in tables and then examined using descriptive statistics and thematic analysis. Key findings are that there is a lack of conceptual clarity regarding social sustainability, and that the field of study is multidisciplinary with distinct thematic research areas (athlete development, athlete health and well‐being, athlete development environment). Most research focuses on athlete‐related micro aspects and less on organizational and societal dimensions. Inequity issues were found regarding social diversity, including an overrepresentation of soccer and men's sports. Furthermore, mostly quantitative methodologies are used. A theoretically based and empirically tested understanding of social sustainability is needed as well as research addressing aspects of holistic youth development. Attention should be paid to contextual and macro‐level influences. Knowledge about preventive programs and practices that advance social sustainability in youth elite sports is necessary. Organizational conditions and funding programs should be created to increase trans‐ or multidisciplinary research.

OBJECTIVES: To (1) compare analgesic use over 36 weeks between endurance athletes, technical athletes, and team athletes, and (2) explore experiences and sociocultural factors impacting analgesic use. DESIGN: Longitudinal mixed-methods study METHODS: Six hundred eighty-nine youth elite athletes (44% girls/women, 15-20 years) provided weekly reports on number of days with analgesic use, reasons for use, and types of analgesics used for 36 weeks. Prevalence and frequency of analgesic use was compared between athletes from team sports, endurance sports, and technical sports using mixed-effects logistic and Poisson regression models. Reasons and types of analgesics used were compared between groups using Chi-square tests. Nine focus group interviews with 32 participants were conducted and analyzed using thematic analysis. RESULTS: There were no differences in odds of analgesic use between endurance athletes (reference group), technical athletes (odds ratio [OR], 0.94; 95% confidence interval [CI]: 0.65, 1.37), and team athletes (OR, 0.88; 95% CI: 0.62, 1.25). Similarly, there were no differences in rate of analgesic use between endurance athletes (reference group), technical athletes (incidence rate ratio [IRR], 0.97; 95% CI: 0.87, 1.07), or team athletes (IRR, 1.03; 95% CI: 0.94, 1.14). Reasons for use varied between groups, while the types of analgesics used were similar. Sociocultural factors impacting analgesic use included considering the potential consequences of using analgesics for pain and injury, and feeling responsible for team performance. CONCLUSION: Analgesics were commonly used among youth elite athletes in Denmark. Analgesic use generally did not vary between team athletes, endurance athletes, and technical athletes. Several norms, values, and structures in sports environments impacted analgesic use. J Orthop Sports Phys Ther 2025;55(5):1-11. Epub 3 April 2025. doi:10.2519/jospt.2025.13015.