2022 Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes at All Participation Levels.

SYNOPSIS: There is an absence of high-quality evidence to support rehabilitation and return-to-sport decisions following shoulder injuries in athletes. The Athlete Shoulder Consensus Group was convened to lead a consensus process that aimed to produce best-practice guidance for clinicians, athletes, and coaches for managing shoulder injuries in sport. We developed the consensus via a 2-round Delphi process (involving more than 40 content and methods experts) and an in-person meeting. This consensus statement provides guidance with respect to load and risk management, supporting athlete shoulder rehabilitation, and decision making during the return-to-sport process. This statement is designed to offer clinicians the flexibility to apply principle-based approaches to managing the return-to-sport process within a variety of sporting backgrounds. The principles and consensus of experts working across multiple sports may provide a template for developing additional sport-specific guidance in the future. J Orthop Sports Phys Ther 2022;52(1):11-28. doi:10.2519/jospt.2022.10952.

[Return to sport and to competition after anterior crusiate ligament reconstruction.] / Retour au sport et à la compétition après reconstruction du ligament croisé antérieur.

The return to sport (RTS) and return to competition (RTC) after anterior cruciate ligament reconstruction (ACLR) in the recreational and professionnel sports population remains a challenge. Previous level of activity, associated injuries, the type of reconstruction, and rehabilitation associated factors such as strength, neuromuscular control, and mobility all influence the RTS and RTC. Psychologic aspects, overall fitness, and patient's expectations equally play an important role. ACLR rehabilitation needs ideally a multi-disciplinary setting and follows functional steps rather than chronological time-lines, with passing criteria until RTS and RTC. Standardized and sport-specific tests are mandatory to evaluated optimal readiness for RTS and RTC.

Le retour au sport (RTS) et à la compétition (RTC) du patient sportif amateur ou d'élite après une reconstruction du ligament croisé antérieur (RLCA) est une décision importante qui nécessite un avis éclairé et partagé entre les différents intervenants dans le traitement. Le niveau et le type d'activité prélésionel, les facteurs liés à la blessure comme les lésions associées, le type de réparation, et ceux liés à la rééducation comme la force, les compétences neuromusculaires et la mobilité influencent tous le RTS et le RTC, sans compter les aspects psychologiques, le niveau de fitness, les attentes et la situation personnelle du patient. La rééducation se fait par étapes fonctionnelles avec des critères de passage jusqu'au RTS et RTC, en collaboration multidisciplinaire. Des tests standardisés et spécifiques au sport pratiqué sont finalement nécessaires pour valider l'aptitude au retour au sport et à la compétition.

[How to choose the ideal graft for anterior cruciate ligament reconstruction]. / Comment choisir le type de greffe pour la reconstruction du ligament croisé antérieur ?

Indication for anterior cruciate ligament reconstruction is a debated subject and needs to be discussed on an individual basis, depending on the patient's age and physical demands. Graft selection is a crucial step for successful outcome and needs to be adapted to the patient, to the concomitant lesions, preoperative knee and lower limb injuries, but also to the surgeon's experience and preference. The present article summarizes current concepts, the pros and cons of the most used autografts and allografts, and highlights the importance to adapt postoperative rehabilitation in function of the graft.

L'indication à la reconstruction du ligament croisé antérieur est sujet à débat et nécessite d'être discutée au cas par cas, selon l'âge du patient et sa demande fonctionnelle. Le choix de la greffe est crucial pour un résultat satisfaisant et repose sur les souhaits du patient, la présence de lésions associées, de douleurs ou comorbidités du membre inférieur ainsi que sur l'habitude et l'expérience du chirurgien. Cet article résume les concepts chirurgicaux, les avantages et inconvénients des types d'autogreffe et d'allogreffe, et indique l'importance de l'adaptation de la rééducation en fonction de la greffe choisie.

Return to sport after patellar dislocation or following surgery for patellofemoral instability.

Patellofemoral instability may occur in a young population as a result of injury during sporting activities. This review focuses on return to sport after one episode of dislocation treated no operatively and as well after surgery for chronic patellofemoral instability. With or without surgery, only two-thirds of patients return to sports at the same level as prior to injury. A high-quality rehabilitation programme using specific exercises is the key for a safe return to sporting activities. To achieve this goal, recovery of muscle strength and dynamic stability of the lower limbs is crucial. The focus should be directed to strengthen the quadriceps muscle and pelvic stabilizers, as well as lateral trunk muscle training. Patient education and regularly performed home exercises are other key factors that can lead to a successful return to sports. The criteria for a safe return to sports include the absence of pain, no effusion, a complete range of motion, almost symmetrical strength, and excellent dynamic stability. Level of evidence IV.

[Scapular dyskinesis]. / Dyskinésie de l'omoplate.

The scapula plays a crucial role for proper shoulder function, serving as a stable base for rotator cuff activation and as a link in the kinetic chain. Joint, ligament or muscular problems near the scapula can lead to malpositions or to an altered movement pattern. This abnormal situation is called "scapular dyskinesis", which appears to be a non-specific response to a painful condition of the shoulder. The clinical examination of the scapula is crucial for every patient presenting a painful shoulder. Systematic observation and testing enable the practitioner to detect subtle static and dynamic abnormalities. Visual evaluation, objective measurements and corrective manoeuvres can evaluate the role of the "scapular dyskinesis" in the shoulder painful condition. The scapular rehabilitation will address muscular retractions and imbalances and restore a good dynamic stability, starting with analytical work, and evolving into more functional and specific exercises.