Reconstructive surgery after distal fibular resection due to bone tumors: a technical report on surgical strategies and results from the PROSPERO international register of systematic reviews.

Purpose: Primary bone tumors of the fibula are rare. Distal fibular resection has a significant impact on ankle biomechanics and gait, possibly leading to complications such as ankle instability, valgus deformity, and degenerative changes. Question: Is there a need for reconstructive surgery after distal fibular resection, and what reconstructive procedures are available? Materials and methods: The review is registered with the PROSPERO International Register of Systematic Reviews. Inclusion criteria consisted of all levels of evidence, human studies, patients of all ages and genders, publication in English, and resection of the distal portion of the fibula due to tumor pathology. The reviewers defined four different categories of interest by method of treatment. Additional articles of interest during full-text review were also added. Results: The initial search resulted with a total of 2958 records. After screening, a total of 50 articles were included in the study. Articles were divided into 'No reconstruction', 'Soft tissue reconstruction', 'Bone and soft tissue reconstruction', and 'Arthrodesis, arthroplasty or other reconstruction options' groups. Conclusion: Limb salvage surgery should be followed by reconstruction in order to avoid complications. Soft tissue reconstructions should always be considered to stabilize the joint after fibular resection. Bone reconstruction with reversed vascularized fibula is the preferred technique in young patients and in cases of bone defects more than 3 cm, while arthrodesis should be considered in adult patients. Whenever possible for oncologic reason, if a residual peroneal malleolus could be preserved, we prefer augmentation with a sliding ipsilateral fibular graft.

Investigating and Practicing Orthopedics at the Intersection of Sex and Gender: Understanding the Physiological Basis, Pathology, and Treatment Response of Orthopedic Conditions by Adopting a Gender Lens: A Narrative Overview.

In the biomedical field, the differentiation between sex and gender is crucial for enhancing the understanding of human health and personalizing medical treatments, particularly within the domain of orthopedics. This distinction, often overlooked or misunderstood, is vital for dissecting and treating musculoskeletal conditions effectively. This review delves into the sex- and gender-specific physiology of bones, cartilage, ligaments, and tendons, highlighting how hormonal differences impact the musculoskeletal system's structure and function, and exploring the physiopathology of orthopedic conditions from an epidemiological, molecular, and clinical perspective, shedding light on the discrepancies in disease manifestation across sexes. Examples such as the higher rates of deformities (adolescent idiopathic and adult degenerative scoliosis and hallux valgus) in females and osteoporosis in postmenopausal women illustrate the critical role of sex and gender in orthopedic health. Additionally, the review addresses the morbidity-mortality paradox, where women, despite appearing less healthy on frailty indexes, show lower mortality rates, highlighting the complex interplay between biological and social determinants of health. Injuries and chronic orthopedic conditions such osteoarthritis exhibit gender- and sex-specific prevalence and progression patterns, necessitating a nuanced approach to treatment that considers these differences to optimize outcomes. Moreover, the review underscores the importance of recognizing the unique needs of sexual minority and gender-diverse individuals in orthopedic care, emphasizing the impact of gender-affirming hormone therapy on aspects like bone health and perioperative risks. To foster advancements in sex- and gender-specific orthopedics, we advocate for the strategic disaggregation of data by sex and gender and the inclusion of "Sexual Orientation and Gender Identity" (SOGI) data in research and clinical practice. Such measures can enrich clinical insights, ensure tailored patient care, and promote inclusivity within orthopedic treatments, ultimately enhancing the precision and effectiveness of care for diverse patient populations. Integrating sex and gender considerations into orthopedic research and practice is paramount for addressing the complex and varied needs of patients. By embracing this comprehensive approach, orthopedic medicine can move towards more personalized, effective, and inclusive treatment strategies, thereby improving patient outcomes and advancing the field.

Ortho-oncoplastic surgery in foot and ankle: A narrative overview on reconstruction of soft-tissue defects after oncologic resections.

INTRODUCTION: Malignant tumors of the foot are rare, and treatment strategies are challenging considering the complex anatomy of this area. In recent years, dramatic advances in technology and collaborations between different specialties (such as orthopedic, oncology, radiology, plastic, and vascular surgery) significantly changed the approach to complex malignant tumors without resorting to limb removal. The combination of the strengths of both orthopedic surgery and plastic surgery constitutes the modern definition of "orthoplasty." The aim of this review article is to provide treatment strategies that are available for reconstruction of foot and ankle in limb-salvage surgery after tumor resection, with a specific focus on microsurgical techniques in plastic surgery. METHODS: We conducted a comprehensive search for relevant papers across PubMed, Scopus, Embase, and Web of Science. We included patient-based studies reporting on procedures for soft-tissue reconstruction with small and large soft tissue defects. Indications, pros and cons, and technique tips are discussed for each type of reconstructive technique. RESULTS: The search was done using literature of the past 30 years (from 1990 to date), resulting in about 725 articles describing over 2000 cases. Cutaneous flaps included lateral supramalleolar flap, medial plantar flap, reverse sural neurocutaneous island flap, medial leg flap, and lateral leg flap. Free flaps included anterolateral thigh flap, radial forearm flap, latissimus dorsi flap, gracilis muscle flap, lateral arm flap, and rectus abdominis flap. CONCLUSIONS: The orthoplastic approach in musculoskeletal oncology is a collaborative model of orthopedic and plastic surgeons working together, resulting in a higher rate of successful limb salvage in patients at risk for amputation. Protocols, biologic substitutes, and surgical techniques are largely improved in the last decades increasing the possibility of functional reconstruction. Microsurgical strategies represent the new frontiers in these demanding reconstructions.

When Is a Two-Stage Surgical Procedure Indicated in the Treatment of Pseudotumors of the Hip? A Retrospective Study of 21 Cases and a Review of the Literature.

(1) Background: A pseudotumor of the hip is a sterile, non-neoplastic soft tissue mass associated with total hip arthroplasties. Pseudotumors may mimic soft tissue tumors or infections, and thus a differential diagnosis is crucial, and biopsy is recommended. The purpose of this study was to compare the complications and functional results between one-stage and two-stage procedures. (2) Methods: We retrospectively analyzed 21 patients surgically treated at our institution with "pseudotumors" associated with hip prosthesis (8 male, 13 female with a mean age of 69 years). One-stage revision was performed in 10 cases and two-stage reversion in 10, with excision only in 1 case. Complications were classified as major and minor and functional results assessed using the Harris Hip Score (HHS). (3) Results: Five patients (24%) reported major complications. The survival rate for all complications was 75%. The overall survival rate was 95% at 5 years. The mean HHS ranged from 35 pre-op to 75 post-op, highlighting improved functional results in all cases. We recorded no differences in complications or functional outcomes between the one- and two-stage procedures. (4) Conclusions: In our experience, the two-stage surgical approach is preferable in cases with major bone defects and larger pseudotumor sizes. The use of custom-made 3D-printed prostheses is increasing and is a further reason to prefer two-stage revision.

Adaptive Shooting Disciplines: A Scoping Review of the Literature with Bibliometric Analysis.

Para-archery and para-shooting, two very popular adaptive shooting disciplines that have earned their place as major official events in the Paralympic Games, share some similarities, as well as distinctive features in terms of rules, physiological requirements, and equipment used. The International Paralympic Committee has a clear responsibility to ensure that all sports within its jurisdiction, including adaptive shooting, can achieve excellence in their respective fields. To achieve this, the conduct of well-designed studies and rigorous research is essential. Although some research has been conducted in this area, a comprehensive and systematic evaluation is still needed. Therefore, the present study aims to provide a thorough review and synthesis of existing research on adaptive shooting disciplines, identify strengths and gaps, and suggest future directions. Arksey and O'Malley's methodology is leveraged and enhanced with bibliometric and policy analyses to review literature on adaptive shooting. Databases like PubMed/MEDLINE, Scopus, Web of Science, OvidSP, and EMBASE were searched, focusing on studies in adaptive shooting disciplines and analysing these findings through a blend of thematic and statistical methods. Twenty-four studies totalling 483 para-athletes (299 para-shooters and 184 para-archers) are included in this scoping review, focusing on a range of aspects, including physiological responses (n = 9), research design and measurement methods for evidence-based classification (n = 6), biopsychosocial aspects (n = 3), development of new methods and technologies (n = 4), kinematic and biomechanical assessment (n = 1), and epidemiology of injuries (n = 1). Seven articles focused exclusively on para-archery, thirteen exclusively on para-shooting, and four on both para-archery and para-shooting. In conclusion, the available literature on adaptive shooting disciplines is still very limited, especially regarding para-archery compared to para-shooting. This highlights the need for further research in many key areas to ensure a better understanding of the different disciplines and to provide appropriate support for para-athletes. Future research in para-archery and para-shooting should focus on technological innovations, biomechanical studies, and psychological support to enhance athlete performance and accessibility. Addressing the imbalance between the two disciplines, along with injury prevention and global participation, can drive the sports towards greater inclusivity and equity for para-athletes worldwide.

Analysis of Kinematic and Muscular Fatigue in Long-Distance Swimmers.

Muscle fatigue is a complex phenomenon that is influenced by the type of activity performed and often manifests as a decline in motor performance (mechanical failure). The purpose of our study was to investigate the compensatory strategies used to mitigate mechanical failure. A cohort of 21 swimmers underwent a front-crawl swimming task, which required the consistent maintenance of a constant speed for the maximum duration. The evaluation included three phases: non-fatigue, pre-mechanical failure, and mechanical failure. We quantified key kinematic metrics, including velocity, distance travelled, stroke frequency, stroke length, and stroke index. In addition, electromyographic (EMG) metrics, including the Root-Mean-Square amplitude and Mean Frequency of the EMG power spectrum, were obtained for 12 muscles to examine the electrical manifestations of muscle fatigue. Between the first and second phases, the athletes covered a distance of 919.38 ± 147.29 m at an average speed of 1.57 ± 0.08 m/s with an average muscle fatigue level of 12%. Almost all evaluated muscles showed a significant increase (p < 0.001) in their EMG activity, except for the latissimus dorsi, which showed a 17% reduction (ES 0.906, p < 0.001) during the push phase of the stroke cycle. Kinematic parameters showed a 6% decrease in stroke length (ES 0.948, p < 0.001), which was counteracted by a 7% increase in stroke frequency (ES -0.931, p < 0.001). Notably, the stroke index also decreased by 6% (ES 0.965, p < 0.001). In the third phase, characterised by the loss of the ability to maintain the predetermined rhythm, both EMG and kinematic parameters showed reductions compared to the previous two phases. Swimmers employed common compensatory strategies for coping with fatigue; however, the ability to maintain a predetermined motor output proved to be limited at certain levels of fatigue and loss of swimming efficiency (Protocol ID: NCT06069440).

Crural and Plantar Fasciae Changes in Chronic Charcot Diabetic Foot: A Cross-Sectional Ultrasound Imaging Study-An Evidence of Fascial Continuity.

Crural fascia (CF) and plantar fascia (PF) are biomechanically crucial in the gait and in the proprioception, particularly in the propulsion phase of the foot during the gait cycle and in the dissipation of forces during weight-bearing activities. Recent studies have revealed an association between increases in PF thickness and diabetes. The purpose of this study was to measure and compare by ultrasound (US) imaging the thickness of the CF and PF at different regions/levels in chronic Charcot diabetic foot patients (group 1) and in healthy volunteers (group 2). A cross-sectional study was performed using US imaging to measure the CF with Pirri et al.'s protocol and PF with a new protocol in a sample of 31 subjects (15 patients and 16 healthy participants). The findings for CF and PF revealed statistically significant differences in the poster region of CF (Post 1: group 1 vs. group 2: p = 0.03; Post 2: group 1 vs. group 2: p = 0.03) and in PF at two different levels (PF level 1: group 1 vs. group 2: p < 0.0001; PF level 2: group 1 vs. group 2: p < 0.0001). These findings suggest that chronic Charcot diabetic foot patients have CF and PF thicker compared to healthy volunteers. The US examination suggests that fascial thicknesses behavior in these patients points out altered fascial remodeling due to diabetes pathology and biomechanical changes.

An Institutional Standardised Protocol for the Treatment of Acute Displaced Midshaft Clavicle Fractures (ADMCFs): Conservative or Surgical Management for Active Patients?

BACKGROUND AND OBJECTIVES: The treatment of acute displaced midshaft clavicle fractures (ADMCFs) is still under debate. The aim of this study was to verify the effectiveness of our institutional protocol by comparing the clinical and radiographic outcomes of two groups of patients with ADMCFs treated operatively and non-operatively. MATERIALS AND METHODS: active patients with a traumatic, isolated non-pathological ADMCF with at least 1-year clinical and radiographic follow up were included. Surgical treatment was performed in the cases where the residual displacement was higher than 140% after the application of a figure-of-eight bandage (F8-B). All other cases were treated conservatively with a F8-B. A total of 134 patients were enrolled and divided into two groups: surgical and conservative groups, with 59 and 75 patients, respectively. Radiological and clinical parameters were evaluated. RESULTS: Good clinical (Constant-Murley Score, the Quick Disability of the Arm, Shoulder and Hand score, and VAS satisfaction) and radiographic outcomes (initial and residual shortening, initial and residual displacement) were obtained for ADMCFs in both groups. Multivariate analysis showed that patients treated conservatively had better clinical outcomes compared to surgically treated patients (p < 0.001). Return to sports was longer in those treated with surgery. Initial shortening was found to impact clinical outcomes as well as initial displacement. None of the patients showed signs of non-union in both groups. CONCLUSIONS: Very good mid-term clinical results can be obtained in adult patients with ADMCFs, conservatively or operatively managed, by applying our institutional treatment protocol based on objective radiographic parameters evaluated in the ER.

Young para-athletes display more hedonic well-being than people with disabilities not taking part in competitive sports: insights from a multi-country survey.

Hedonic well-being relates to how individuals experience and rate their lives. People with disabilities due to their pathology may more frequently suffer from anxiety and depressive disorders than their able-bodied counterparts. Sports participation is an essential way to cope with disability. On the other hand, compared with their able-bodied peers, para-athletes undergo a unique series of stressors. Little is known in terms of hedonic well-being in this specific population. We present the results of a multi-country survey of self-perceived hedonic well-being by para-athletes of different sports disciplines and a control group (disabled individuals not playing competitive sports), using the "Psychological General Well-Being Index" (PGWBI). We included 1,208 participants, aged 17.39 years, 58.4% male, 41.6% female, and 70.3% para-athletes. Para-athletes exhibited higher well-being than disabled people, for all domains of the PGWBI scale. The nature of disability/impairment was significant, with those with acquired disability reporting lower well-being. Those taking part in wheelchair basketball, para-athletics, and para-swimming competitions had a higher likelihood of reporting well-being, whereas those engaged in wheelchair rugby exhibited lower well-being compared with controls. This large-scale investigation can enable a better understanding of the self-perceived hedonic well-being of disabled people.

Flatfoot over the centuries: the background of current conservative and operative treatments.

PURPOSE: Although flatfoot is a widespread human condition, historical medical texts and ancient illustrations on this deformity are extremely rare. Nowadays, doubts regarding its management remain unsolved. This historical review aims to identify the presence of pes planus since the prehistoric era and examine the treatments proposed over the centuries up to the present. METHOD: For this propose, we performed an extensive electronic search of the relevant literature, complemented by a manual search of additional sources from archaeological to artistic, literary, historical, and scientific accounts, describing flatfoot and its treatment in different eras. RESULTS: Flatfoot accompanied the evolutionary timeline of human species: from Lucy Australopithecus to Homo Sapiens. It was described among various diseases suffered by Tutankhamun (1343-1324 B.C.), while the first anatomical description dates to Emperor Trajan (53-117 A.D.) and the medical studies of Galen (129-201 A.D.). It was also represented in the anatomical drawings of Leonardo da Vinci (1452-1519) and Girolamo Fabrici d'Acquapendente (1533-1619). Historically, the conservative treatment by insoles was the only one proposed until the nineteenth century. Since then, the most popular surgical procedures performed for correction have been osteotomies, arthrodesis, arthrorisis, and tendon lengthening and transfer. CONCLUSION: During the centuries, conservative therapeutic strategies have not radically changed in their substance, while operative ones have become the protagonists during the twentieth century up to the present. Nevertheless, after more than 2000 years of history, there is no consensus regarding the best indication for the flatfoot and if it really needs to be treated.

Malignant Bone and Soft Tissue Lesions of the Foot.

Malignant tumors of the foot are rare pathologies that can involve the skin, soft tissue, or bone. Due to their rarity, they are often misdiagnosed, resulting in inadequate excision and poor outcomes. A correct approach with a careful examination and radiological study, followed by a properly performed biopsy, is thus mandatory to avoid these pitfalls. The present article reviews the most common malignant bone and soft tissue lesions of the foot region, discussing their clinicopathological presentation, imaging features, and current concepts in treatment.

History of the management of talar fractures: from the fall of king Darius to Garibaldi's bullet and from the earliest to current operative strategies.

PURPOSE: This historical review aims to highlight the important roles of the talus in antiquity and to summarise the multiple attempts of managing talar fractures throughout history. METHOD: Archaeological, religious, artistic, literary, historical and scientific accounts were searched for the descriptions of talus fractures in different eras and their treatments to provide a thorough analysis of the evolution of trauma care up to the present. RESULTS: This review shows how the talus has always had an important role in several societies: it was used as a die or considered to have a divinatory function in Mesopotamian civilisations, among Greeks and Romans, in Mongolia and in pre-Columbian Americas. Famous talus fractures are recorded in Herodotus' Histories and in the Acts of the Apostles. We report the earliest injuries described and the first operative managements between 1600 and 1800, including the one that saved Garibaldi's life in 1862, until the modern osteosynthesis by the first screws and nails and the current fixation by plating. CONCLUSION: The blooming of orthopaedic surgery at the end of nineteenth century and the high volume of traumas managed in the World Wars brought a better understanding of fracture patterns and their operative treatment. By the work of Hawkins and his classification, the introduction of the CT scan, a better knowledge of injury modalities and bone vascularisation, these challenging injuries finally land in the contemporary era without mysteries. The subsequently developed surgical procedures, although not guaranteeing success, greatly reduce the risk of necrosis and complication rate, improving patient outcomes.

A Scoping Review with Bibliometric Analysis of Para-Rowing: State of the Art and Future Directions.

Para-rowing is a format of rowing practiced by people with different types of disabilities, thanks to adapted equipment set-ups and regulations. Para-rowing made its debut recently at the 2008 Paralympic Games. According to the mandate of the "International Paralympic Committee", para-rowers should be enabled to pursue sporting excellence. Therefore, rigorous research is needed in terms of well-designed, high-quality studies. To the best of our knowledge, there are no systematic appraisals of the body of scholarly evidence in the field of para-rowing. As such, a scoping review enhanced by bibliometric analyses was carried out to provide a comprehensive synthesis of knowledge related to para-rowing for the perusal of practitioners and athletes. By mining eighteen major databases, 17 studies were retained in the present review. The included studies were found to focus on a range of aspects involving health, the etiology of injuries (n = 5), psychological and physiological responses (n = 5), performance, biomechanical analysis (n = 4), and new analytical approaches for kinematic assessments and predictions of mechanical outputs in para-rowers (n = 3). The scholarly community on para-rowing consists of 78 researchers, 16 (20.51%) of whom are highly interconnected. The most prolific author was Smoljanovic T., from Croatia, with three items/documents. In total, 93.6% of scholars have authored one single document. Topological features indicated a highly fragmented and dispersed, poorly connected community characterized by a high number of clusters and a low strength of connections. In terms of publication years, the first scholarly article dates back to 2008, with four articles (23.5%) published in the current year, showing an increasing interest in this para-sports discipline. Finally, gaps in current research on para-rowing were identified in terms of overlooked topics, including sports nutrition, doping, and psychological aspects in para-rowers other than those with visual impairment.

Functional autonomy and 12-month mortality in older adults with proximal femoral fractures in an orthogeriatric setting: risk factors and gender differences.

BACKGROUND: Proximal femur fractures have a negative impact on loss of functional autonomy and mortality. OBJECTIVE: The aim of this retrospective study was to evaluate functional autonomy and mortality in a group of older adults with hip fractures managed in an orthogeriatric setting 12 months after discharge and to determine if gender affected outcome. METHODS: In all participants, we assessed clinical history, functional pre-fracture status using activities of daily living (ADL) and in-hospital details. At 12 months after discharge, we evaluated functional status, place of residence, hospital readmissions and mortality. RESULTS: We studied 361 women and 124 men and we observed a significant reduction in the ADL score at 6 months (1.15 ± 1.58/p < 0.001 in women and 1.45 ± 1.66/p < 0.001 in men). One-year mortality (33.1% in men and 14.7% in women) was associated with pre-fracture ADL score and reduction in ADL at 6 months (HR 0.68/95%, CI 0.48-0.97/p < 0.05 and HR 1.70/95%, CI 1.17-2.48/p < 0.01, respectively) in women, and new hospitalisations at 6 months and polypharmacy in men (HR 1.65/95%, CI 1.07-2.56/p < 0.05 and HR 1.40/95%, CI 1.00-1.96/p = 0.05, respectively) in Cox's regression model. DISCUSSION AND CONCLUSIONS: Our study suggests that functional loss in older adults hospitalised for proximal femur fractures is greatest in the first 6 months after discharge, and this increases the risk of death at 1 year. Cumulative mortality at 12 months is higher in men and appears to be related to polypharmacy and new hospital admissions 6 months after discharge.

Defective excitation-contraction coupling and mitochondrial respiration precede mitochondrial Ca2+ accumulation in spinobulbar muscular atrophy skeletal muscle.

Polyglutamine expansion in the androgen receptor (AR) causes spinobulbar muscular atrophy (SBMA). Skeletal muscle is a primary site of toxicity; however, the current understanding of the early pathological processes that occur and how they unfold during disease progression remains limited. Using transgenic and knock-in mice and patient-derived muscle biopsies, we show that SBMA mice in the presymptomatic stage develop a respiratory defect matching defective expression of genes involved in excitation-contraction coupling (ECC), altered contraction dynamics, and increased fatigue. These processes are followed by stimulus-dependent accumulation of calcium into mitochondria and structural disorganization of the muscle triads. Deregulation of expression of ECC genes is concomitant with sexual maturity and androgen raise in the serum. Consistent with the androgen-dependent nature of these alterations, surgical castration and AR silencing alleviate the early and late pathological processes. These observations show that ECC deregulation and defective mitochondrial respiration are early but reversible events followed by altered muscle force, calcium dyshomeostasis, and dismantling of triad structure.

The Effect of Verbal Encouragement on Performance and Muscle Fatigue in Swimming.

Background and Objectives: Verbal encouragement (VE) can be used to enhance performance in several sports, even though no studies have been conducted among swimmers and only a few effects have been reported in elite athletes. Besides influencing motor performance, VE is also known to enhance the physical load, thus potentially increasing the probability of developing fatigue. With this in mind, this study aimed to explore the effects of VE in swimmers in order to fill in the knowledge gap concerning the aquatic environment. Materials and Methods: Each athlete swam a maximal 200 m freestyle trial under two different conditions: one trial with VE and the other without VE. The two main outcome measures were: (1) performance velocity (m/s); and (2) muscle fatigue, investigated by means of surface electromyography. Sixty swimmers were recruited, aged 18.63 ± 3.46 years (median 18 years), 28 men (47%), and 32 women (53%), with 7.03 ± 3.9 years of experience. Results: With VE, performance significantly improved in the swim trial (p < 0.001, effect size (ES) −0.95, large). When breaking the results down into the first half (first (0−100 m) vs. the second half (100−200 m)), the ES was large in the first part (−1.11), indicating an improvement in performance. This worsened, however, in the second part of the trial (ES 0.63). In the multivariate analysis, years of experience were found to be a significant predictor of the change in overall performance (p = 0.011). There was a significant increase in muscle fatigue induced by VE, overall, and during the second half, but not during the first half of the trial. Conclusions: The present study indicates that VE during a middle-distance event (200 m) increases performance most in swimmers with little experience. However, it has a negative impact on fatigue.

Digital Ischemia after Ultrasound-Guided Alcohol Injection for Morton's Syndrome: Case Report and Review of the Literature.

The therapeutic algorithm for symptomatic Morton's syndrome is not standardized as several managements have been proposed. Ultrasound-guided alcohol injection (USGAI) is one of the non-operative procedures described. This report presents the case of digital ischemia that occurred after alcoholization for the treatment of Morton's syndrome. This complication is described for the first time in the scientific literature, and it should not only be added to the list of sequalae of USGAI, but more importantly, it should also be explained to the patient when this alternative treatment to traditional surgery is proposed.

A tale of two stories: COVID-19 and disability. A critical scoping review of the literature on the effects of the pandemic among athletes with disabilities and para-athletes.

The still ongoing COVID-19 pandemic has dramatically impacted athletes, and, in particular, para-athletes and athletes with disabilities. However, there is no scholarly appraisal on this topic. Therefore, a critical scoping review of the literature was conducted. We were able to retrieve sixteen relevant studies. The sample size ranged from 4 to 183. Most studies were observational, cross-sectional, and questionnaire-based surveys, two studies were interventional, and two were longitudinal. One study was a technical feasibility study. Almost all studies were conducted as single-country studies, with the exception of one multi-country investigation. Five major topics/themes could be identified: namely, 1) impact of COVID-19-induced confinement on training and lifestyles in athletes with disabilities/para-athletes; 2) impact of COVID-19-induced confinement on mental health in athletes with disabilities/para-athletes; 3) impact of COVID-19-induced confinement on performance outcomes in athletes with disabilities/para-athletes; 4) risk of contracting COVID-19 among athletes with disabilities/para-athletes; and, finally, 5) impact of COVID-19 infection on athletes with disabilities/para-athletes. The scholarly literature assessed was highly heterogeneous, with contrasting findings, and various methodological limitations. Based on our considerations, we recommend that standardized, reliable tools should be utilized and new, specific questionnaires should be created, tested for reliability, and validated. High-quality, multi-center, cross-countries, longitudinal surveys should be conducted to overcome current shortcomings. Involving all relevant actors and stakeholders, including various national and international Paralympic Committees, as a few studies have done, is fundamental: community-led, participatory research can help identify gaps in the current knowledge about sports-related practices among the population of athletes with disabilities during an unprecedented period of measures undertaken that have significantly affected everyday life. Moreover, this could advance the field, by capturing the needs of para-athletes and athletes with disabilities and enabling the design of a truly "disability-inclusive response" to COVID-19 and similar future conditions/situations. Furthermore, follow-up studies on COVID-19-infected para-athletes and athletes with disabilities should be conducted. Evidence of long-term effects of COVID-19 is available only for able-bodied athletes, for whom cardiorespiratory residual alterations and mental health issues a long time after COVID-19 have been described.