The identification and management of neuropsychiatric symptoms following traumatic brain injury (TBI) is a complex and evolving subject matter. This article highlights the vast array of neuropsychiatric symptoms experien...The identification and management of neuropsychiatric symptoms following traumatic brain injury (TBI) is a complex and evolving subject matter. This article highlights the vast array of neuropsychiatric symptoms experienced after a TBI. While numerous pharmacologic and nonpharmacologic interventions show promise, the heterogeneity of patient presentations and injury mechanisms necessitates an individualized and multidisciplinary approach to treatment involving multifaceted treatment plans.
Cardiac autonomic dysfunction is a well-established sequela of concussions, most commonly manifesting in the postconcussive period. Athletes are typically susceptible to these forms of injury. This article summarizes the...Cardiac autonomic dysfunction is a well-established sequela of concussions, most commonly manifesting in the postconcussive period. Athletes are typically susceptible to these forms of injury. This article summarizes the scope of existing research on this topic, providing evidence and clinical experience of the evaluation, diagnostic modalities, differential diagnoses, and treatment considerations from the sports cardiology perspective.
Traumatic brain injury (TBI) is a common injury with detrimental effects on the patients, families, and on national health care expenditure. Computed tomography (CT) scans are commonly utilized in the emergency room for...Traumatic brain injury (TBI) is a common injury with detrimental effects on the patients, families, and on national health care expenditure. Computed tomography (CT) scans are commonly utilized in the emergency room for evaluation of TBI but are not always necessary and can lead to unnecessary radiation exposure and financial expense. In the past decade or so, there has been a surge of research on the efficacy of various biomarkers and imaging techniques to diagnose and manage TBI. The purpose of this article is to provide a review of this literature on biomarkers and advanced imaging techniques for head injuries.
Post-traumatic headache (PTH) is a common sequela following mild traumatic brain injury. In recent years, there has been a growing recognition toward the cervical spine and its structures as an identified contributor tow...Post-traumatic headache (PTH) is a common sequela following mild traumatic brain injury. In recent years, there has been a growing recognition toward the cervical spine and its structures as an identified contributor toward one's symptoms. In this article, we discuss various etiologies including the cervical facet joints, musculoligamentous structures, occipital nerves, and cervical discs, and how they may contribute to PTH. For each of these conditions, common clinical presentation, diagnosis, and therapeutic approaches are discussed.
A concussion can significantly impact how the world is viewed when visual skills are affected. Eye fatigue, blurry vision, double vision, and difficulty moving the eyes smoothly together can contribute to the common symp...A concussion can significantly impact how the world is viewed when visual skills are affected. Eye fatigue, blurry vision, double vision, and difficulty moving the eyes smoothly together can contribute to the common symptoms of nausea and dizziness that frequently occur after a concussion. Dysregulation of the ability to turn the head and focus on an object simultaneously can affect our participation in daily activities such as washing hair, driving, reading, and participating in sports and exercise. Occupational therapy can play a vital role in assessing and treating the functional visual impairments from concussion as part of a multidisciplinary team approach.
Sports-related concussions (SRC) affect millions annually in the United States, with physical therapy playing a vital role in rehabilitation. SRC symptoms fall into 4 key areas: cervicogenic, vestibulo-ocular, physiologi...Sports-related concussions (SRC) affect millions annually in the United States, with physical therapy playing a vital role in rehabilitation. SRC symptoms fall into 4 key areas: cervicogenic, vestibulo-ocular, physiologic, and mood-related. Cervical and vestibular dysfunctions contribute to headaches, dizziness, and balance issues, requiring manual therapy, exercise, and education. Vestibulo-ocular impairments affect gaze stabilization and posture, necessitating targeted interventions. Cognitive deficits may persist, requiring individualized rehabilitation. Anxiety and mood disturbances, whether primary or secondary, benefit from education and graded exercise. This article highlights the importance of physical therapy, and an evidence-based approach in optimizing recovery and safe return to activity post-SRC.
Previous treatment of concussion included absolute cognitive and physical rest until asymptomatic, with no activity from beginning until the individuals were asymptomatic. This is no longer recommended, and new guideline...Previous treatment of concussion included absolute cognitive and physical rest until asymptomatic, with no activity from beginning until the individuals were asymptomatic. This is no longer recommended, and new guidelines recommend starting daily activities, including walking within 24 hours of injury, with parameters surrounding symptom exacerbation and subthreshold exercise. With evidence surrounding the increased risk of musculoskeletal injury following a sport-related concussion, adding motor control and cognitive functional skills before returning to full sports participation is essential. Individualizing treatment plans is necessary for adding activity in a stepwise progression according to the athlete's signs and symptoms and the sport-specific requirements.
Concussion symptoms are inherently nonspecific for concussion and many mimicking conditions exist. The biomechanics of the injury, the athlete's past medical history, their family history, and objective clinical examinat...Concussion symptoms are inherently nonspecific for concussion and many mimicking conditions exist. The biomechanics of the injury, the athlete's past medical history, their family history, and objective clinical examination tools must be included in the initial evaluation to improve diagnostic certainty from the outset. This article discusses these influences and provides a framework for a clinically informed approach and reviews the most common mimicking conditions of concussion. When appropriate, the early identification of mimicking conditions at initial evaluation of the head injury, rather than its identification after prolonged recovery from a misdiagnosis of concussion, is the goal.
Concussion occurs when a traumatic force of impact to the body or to the head results in a neurologic syndrome characterized by the acute onset of physical, cognitive, emotional, and sleep disruption that typically resol...Concussion occurs when a traumatic force of impact to the body or to the head results in a neurologic syndrome characterized by the acute onset of physical, cognitive, emotional, and sleep disruption that typically resolves over 2 weeks. Concussion diagnosis is based on a careful history and physical examination by an experienced provider and can be supplemented by objective tools that measure cognition, ocular tracking, and/or neurophysiology. Concussion management focuses on relative rest and gradual return to cognitive exertion. Evidence also supports early return to physical exercise, monitoring for symptom exacerbation.
Concussion, a form of mild traumatic brain injury, can occur due to direct or indirect forces resulting in transient neurological dysfunction. Several biomechanical forces may play a role in the number and severity of co...Concussion, a form of mild traumatic brain injury, can occur due to direct or indirect forces resulting in transient neurological dysfunction. Several biomechanical forces may play a role in the number and severity of concussion symptoms. Protective gear such as helmets, mouthguards, and headgear may offer varying levels of efficacy regarding prevention depending on the sport and setting. Advancing our understanding of concussion biomechanics for specific sports settings may aid in individualizing care strategies aimed at increasing diagnostic capabilities, prevention through protective equipment development, and long-term outcomes in high-risk groups.
Concussion is a complex brain injury affecting neurons and nonneuronal cells such as astrocytes, oligodendrocytes, microglia, and endothelial cells, leading to acute neurometabolic disturbances such as ionic imbalance an...Concussion is a complex brain injury affecting neurons and nonneuronal cells such as astrocytes, oligodendrocytes, microglia, and endothelial cells, leading to acute neurometabolic disturbances such as ionic imbalance and energy crisis. Beyond metabolism, these cellular responses may drive inflammation, blood-brain barrier disruption, neuroplasticity, glymphatic dysfunction, and neurodegeneration. Recognizing biological vulnerability and knowledge regarding repeat concussions has shaped protocols to prevent premature return to activity and reduce further injury risk. The concept of concussion and postconcussion endotypes, linking persistent symptoms to specific biological mechanisms, guides targeted diagnosis and treatment. Ongoing research into biomarkers and mechanisms aims to improve prognostication and develop personalized treatments for recovery.
Clin Sports Med
· 2026 Jan · PMID 41207761
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The excessive mechanical stress of valgus alignment can accelerate cartilage breakdown and meniscal damage in patients with lateral compartment disease. A varus-producing distal femoral osteotomy can shift the load away...The excessive mechanical stress of valgus alignment can accelerate cartilage breakdown and meniscal damage in patients with lateral compartment disease. A varus-producing distal femoral osteotomy can shift the load away from the damaged compartment. This procedure helps alleviate mechanical stress and reduces the burden on concomitant or staged cartilage and meniscal procedures, ultimately preserving the joint. The medial closing-wedge approach offers the benefit of direct native bone contact, thereby enhancing structural integrity and promoting reliable healing.
Schroeder GG, Albersheim M, Vel MS
… +1 more, Sherman SL
Clin Sports Med
· 2026 Jan · PMID 41207760
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Lateral opening wedge distal femoral osteotomy (LOWDFO) is a good surgical option for active patients with valgus malalignment and lateral compartment knee pathology. The technique involves making an opening wedge osteot...Lateral opening wedge distal femoral osteotomy (LOWDFO) is a good surgical option for active patients with valgus malalignment and lateral compartment knee pathology. The technique involves making an opening wedge osteotomy on the lateral aspect of the distal femur to correct valgus deformity. There are pros and cons of LOWDFO compared with medial closing wedge distal femoral osteotomy, but overall there are no major clinical outcomes differences. With appropriate technique, complications such as fracture, neurovascular injury, symptomatic hardware, and nonunion can be minimized.
Guarino A, Cance N, Giovannetti de Sanctis E
… +2 more, Mariconda M, Dejour D
Clin Sports Med
· 2026 Jan · PMID 41207759
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Anterior cruciate ligament (ACL) deficiency leads to knee instability and increased joint degeneration. While ACL reconstruction (ACLR) is common, a steep posterior tibial slope (PTS) raises the risk of graft failure. An...Anterior cruciate ligament (ACL) deficiency leads to knee instability and increased joint degeneration. While ACL reconstruction (ACLR) is common, a steep posterior tibial slope (PTS) raises the risk of graft failure. Anterior closing wedge osteotomy (ACWO), or tibial deflexion osteotomy, is an effective surgical option for high PTS, especially in revision cases. ACWO alters tibial slope, reducing strain on ACL grafts and improving stability. With excellent long-term outcomes, including low rerupture rates and good return-to-sport results, ACWO is effective in cases with increased tibial slope and static anterior tibial translation, though its role in primary ACLR is still debated.
Featherall J, Kanakamedala A, Rothrauff B
… +1 more, Vidal AF
Clin Sports Med
· 2026 Jan · PMID 41207758
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The medial closing wedge high tibial osteotomy functions to mechanically offload the lateral compartment of the knee and correct valgus deformity. This osteotomy offloads the lateral compartment in both knee extension an...The medial closing wedge high tibial osteotomy functions to mechanically offload the lateral compartment of the knee and correct valgus deformity. This osteotomy offloads the lateral compartment in both knee extension and flexion, providing an advantage over the lateral opening wedge distal femoral osteotomy and medial closing wedge distal femoral osteotomy. This review provides a brief discussion of the indications and clinical and biomechanical data surrounding this osteotomy and focuses in detail on the technical execution of this procedure.
Clin Sports Med
· 2026 Jan · PMID 41207757
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The Medial Opening Wedge High Tibial Osteotomy (MOWHTO) is a powerful procedure in the toolbox of orthopedic surgeons. It continues to play a role in managing younger patients with medial compartment osteoarthritis (OA)....The Medial Opening Wedge High Tibial Osteotomy (MOWHTO) is a powerful procedure in the toolbox of orthopedic surgeons. It continues to play a role in managing younger patients with medial compartment osteoarthritis (OA). Orthopedic surgeons are aware that the natural history of a medial meniscus deficient knee or a patient with a significant chondral defect on the medial femoral condyle with a varus malalignment will proceed to OA. With further advances, MOWHTO will be performed earlier and more frequently with medial meniscal and chondral restorative procedures.
White AE, Megerian MF, Raghuram AK
… +2 more, Alaia MJ, Ranawat AS
Clin Sports Med
· 2026 Jan · PMID 41207756
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Patient-specific instrumentation (PSI) may help improve outcomes following high tibial osteotomy (HTO). Three-dimensional preoperative planning allows for multiplanar osteotomy templating that can precisely restore the m...Patient-specific instrumentation (PSI) may help improve outcomes following high tibial osteotomy (HTO). Three-dimensional preoperative planning allows for multiplanar osteotomy templating that can precisely restore the mechanical axis while limiting unintended sagittal plane abnormalities, facilitating execution of complex biplanar corrections. Patient-specific cutting guides and anatomically contoured implants reduce risk for intraoperative complications and streamlines operative efficiency. Though lacking long-term data to establish clinical superiority of PSI over traditional HTO techniques, early reports demonstrate PSI is highly accurate, safe, and effective. Understanding the advantages and limitations of PSI is crucial in making informed decisions when implementing this new technology in osteotomy surgery.
Clin Sports Med
· 2026 Jan · PMID 41207755
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In this review, the authors classify and categorize the most common intraoperative and postoperative surgical and medical complications associated with knee osteotomies of the distal femur and proximal tibia. They review...In this review, the authors classify and categorize the most common intraoperative and postoperative surgical and medical complications associated with knee osteotomies of the distal femur and proximal tibia. They review the available literature to date regarding the incidence, risk factors, and morbidity associated with each complication and how these have evolved over recent years. Finally, they summarize what is known regarding the prevention and management strategies of each complication and the level of evidence associated with varying strategies.