British medical bulletin最新文献

{"title":"Knee physeal stress injury and osteochondrosis in pediatric athletes: a systematic review.","authors":"Julian Forero-Millan, Bemnet T Gebregiorgis, Ali Işın, Geoffrey L Liu, Dennis Caine, Jie C Nguyen","doi":"10.1093/bmb/ldag036","DOIUrl":"https://doi.org/10.1093/bmb/ldag036","url":null,"abstract":"<p><strong>Background: </strong>Epiphyseal physeal stress injuries (PSIs) and articular osteochondroses of the knee in pediatric athletes are incompletely understood. Delayed diagnosis can lead to growth arrest and osseous deformity, increasing the need for surgical correction and long-term morbidity.</p><p><strong>Sources of data: </strong>A systematic review was performed using PRISMA guidelines. PubMed, Scopus, and Embase databases were searched to identify peer-reviewed publications on the occurrence, diagnosis, and outcome of epiphyseal PSIs and articular osteochondroses of the knee in skeletally immature pediatric athletes, yielding 16 articles (26 patients: 17 males and 9 females; 31 knees). Study quality, demographic data, sports activity, imaging findings, treatment, and outcomes were collected and summarized using descriptive statistics.</p><p><strong>Areas of agreement: </strong>There is a relative paucity of data on epiphyseal PSIs and articular osteochondroses affecting the knee. Radiographs and MRI are commonly used for evaluation. Treatment typically begins with conservative management; surgical intervention is considered when conservative treatment fails or substantial growth disturbance or skeletal deformity is present.</p><p><strong>Areas of controversy: </strong>The optimal duration of conservative treatment and the indications, timing, and type of surgical intervention remain uncertain because the available evidence is limited.</p><p><strong>Growing points: </strong>Early radiographic findings of epiphyseal PSIs or articular osteochondroses of the knee are often subtle, and MRI may be needed to clarify the diagnosis and exclude alternative diagnoses.</p><p><strong>Areas timely for developing research: </strong>Surveillance across youth sports should include epiphyseal PSIs and articular osteochondroses of the knee. Prospective longitudinal epidemiological and imaging studies are needed to better characterize incidence, prevalence, natural history, and complication rates.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"160 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149243148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical predictors of type II endoleaks after EVAR: a systematic review of risk and protective factors.","authors":"Giulia Colonna, Chiara Fasulo, Mario Antonelli, Anna Santini, Costanza Morucci, Ginevra Mazzetti, Luigi Rizzo, Maurizio Taurino, Pasqualino Sirignano","doi":"10.1093/bmb/ldag035","DOIUrl":"10.1093/bmb/ldag035","url":null,"abstract":"<p><strong>Introduction: </strong>The present systematic review seeks to examine clinical factors potentially associated with endovascular aortic aneurysm repair (EVAR) failure due to type II endoleaks (TIIEL).</p><p><strong>Source of data: </strong>Relevant literature was sourced from PubMed, including all studies regarding clinical features possibly linked to TIIEL, written in English. Studies focused on anatomical predictors, case reports, and abstracts were excluded. The literature search used keywords related to clinical characteristics, comorbidities, and demographics common in EVAR patients.</p><p><strong>Areas of agreement: </strong>EVAR is the preferred treatment for abdominal aortic aneurysms in eligible patients. The most common complication is endoleak (persistent filling of the sac). TIIEL is caused by retrograde blood flow from aortic side branches and is the most frequent complication, occurring in 16%-50% of cases.</p><p><strong>Areas of controversy: </strong>Many studies have explored anatomical predictors of TIIEL, but limited research is available on clinical factors that may contribute to its occurrence.</p><p><strong>Growing points: </strong>Protective factors against TIIEL included statin therapy, salicylate therapy, smoking, ankle/brachial systolic blood pressure index <0.87, and chronic obstructive pulmonary disease. Conversely, anticoagulation therapy, inflammatory status, and advanced age were associated with an increased risk of TIIEL.</p><p><strong>Areas timely for developing research: </strong>Further prospective research is needed to validate the presented association between clinical factors and EVAR failure due to TIIEL, to allow risk stratification and tailored follow-up strategies for selected groups of patients.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"160 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Donor site morbidity after autologous bone graft harvesting for fracture nonunion: a systematic review and comparative analysis of four techniques.","authors":"Grayson Norris, Sean Young, Bryce Sanchez, Joshua Major, Nicholas Pettinelli, Brent Norris","doi":"10.1093/bmb/ldag038","DOIUrl":"https://doi.org/10.1093/bmb/ldag038","url":null,"abstract":"<p><strong>Introduction: </strong>Autologous bone grafting is the reference standard for fracture nonunion; however, donor site morbidity remains a primary concern across all harvesting techniques.</p><p><strong>Sources of data: </strong>A systematic search of PubMed and Embase was performed from January 2011 to March 2026, chosen to capture the 15-year period since the landmark 2011 review of autograft harvest complications by Dimitriou et al., in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 49 studies comprising 3029 graft sites across four autograft harvesting techniques were included.</p><p><strong>Areas of agreement: </strong>Complication profiles are highly technique-dependent. ICBG demonstrated the lowest overall complication rate (5.83%). Fibular strut grafts demonstrated similarly favourable morbidity (4.88%). Significant differences in overall complication rates were identified between ICBG and reamer-irrigator-aspirator (RIA) (P = .0008) and between ICBG and PK (P < .0001).</p><p><strong>Areas of controversy: </strong>RIA has historically been considered lower morbidity than ICBG; however, the present analysis demonstrated a higher overall complication rate for RIA (9.40%), driven primarily by transfusion requirements (7.88%). This finding likely reflects broader use of RIA in more complex nonunion presentations and improved recognition of transfusion-related risk.</p><p><strong>Growing points: </strong>Periarticular knee harvesting demonstrated the highest overall complication rate (13.64%), challenging its perception as a uniformly low-morbidity technique. Future studies with larger per-subtype cohorts are needed to compare these independently.</p><p><strong>Areas for developing research: </strong>Prospective, multicentre cohort studies employing standardized complication definitions and adequate follow-up durations are needed to overcome the heterogeneity inherent to the current retrospective literature.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"160 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Little league shoulder revisited: a systematic review of the last decade.","authors":"Annika Lenz, Luke Johnson, Mark Riederer, Aaron Provance","doi":"10.1093/bmb/ldag044","DOIUrl":"10.1093/bmb/ldag044","url":null,"abstract":"<p><strong>Background: </strong>Physeal stress injuries involving the shoulder epiphyseal growth plate complex, known as Little League Shoulder (LLS), occur primarily in skeletally immature overhead athletes.</p><p><strong>Sources of data: </strong>This systematic review included research on LLS published within the last 10 years, from 1 January 2015 through 23 September 2025, from four electronic databases (Embase, PubMed, SPORTDiscus, Cochrane Library) focusing on diagnosis, management, imaging, and criteria for return-to-sport.</p><p><strong>Areas of agreement: </strong>LLS is mainly described in male, skeletally immature overhead athletes aged 11-15. Early specialization, multi-team participation, and inadequate rest are reported risk factors. LLS commonly presents with throwing-related shoulder pain, proximal humeral physis tenderness, posterior capsule tightness, and scapular dyskinesia. X-rays remain first-line imaging, demonstrating lateral physeal widening and irregularity. Throwing cessation for 2-4 months, followed by rehabilitation and gradual return-to-throwing yields excellent short-term outcomes, with low rates of growth disturbance. Prevention strategies include pitch-counts, rest, proper throwing mechanics, and delayed specialization.</p><p><strong>Areas of controversy: </strong>The prevalence of LLS remains unknown due to variable diagnostic criteria, imaging use, and underreporting. Recurrence and long-term sequelae are inconsistent across studies, and the reasons athletes discontinue baseball remain uncertain. Evidence is conflicting regarding the benefits of formal rehabilitation compared with rest alone.</p><p><strong>Growing points: </strong>Advanced imaging demonstrates structural remodeling of the shoulder, suggesting that repetitive loading during skeletal immaturity impacts long-term morphology and mechanics.</p><p><strong>Areas timely for developing research: </strong>Prospective studies using clinical and imaging criteria may help define the incidence, severity, risk factors, sport-specific patterns, and to clarify symptom resolution, humeral remodeling, and factors influencing attrition. Longitudinal studies should compare rest versus structured rehabilitation and varying return-to-throwing protocols.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"160 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13725757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149318200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In vivo animal models of Achilles tendon rupture management: a narrative review.","authors":"Nicola Maffulli, Filippo Spiezia, Francesco Oliva","doi":"10.1093/bmb/ldag032","DOIUrl":"https://doi.org/10.1093/bmb/ldag032","url":null,"abstract":"<p><strong>Introduction: </strong>Acute Achilles tendon rupture is common, and the balance between surgical and non-surgical management remains contested. Much of the mechanistic evidence informing this debate derives from in vivo animal models, which have not previously been appraised together as a class.</p><p><strong>Sources of data: </strong>PubMed/MEDLINE was searched using terms for the Achilles/calcaneal tendon combined with terms for rupture, transection, tenotomy, defect, repair and relevant animal species. Reference lists of included studies and pertinent reviews were hand-searched, supplemented by a grey-literature/web sweep. The search was last updated in June 2026. Given the marked heterogeneity of species, injury model, intervention and outcome measures, findings are synthesized narratively rather than pooled quantitatively or scored against a structured risk-of-bias instrument.</p><p><strong>Areas of agreement: </strong>Twenty-four in vivo studies (predominantly rat, with mouse, rabbit and one sheep model) were identified. Immobilization angle and duration, rather than repair per se, appear to be dominant determinants of early healing. Biological and pharmacological augmentation strategies generally improve biomechanical properties, with less consistent histological change.</p><p><strong>Areas of controversy: </strong>Controversies in this literature are of two kinds, substantive and methodological. Direct comparisons of repair versus non-repair are scarce, and reach divergent conclusions once immobilization is accounted for. Reporting of randomization, allocation concealment, blinding and sample-size justification is inconsistent and often absent.</p><p><strong>Growing points: </strong>Cell- and vesicle-based therapies, engineered scaffolds and lineage-tracing/mechanistic models are actively reshaping this literature.</p><p><strong>Areas timely for developing research: </strong>Consensus reference models with standardized transection, repair and immobilization protocols, explicit reporting of ankle angle, duration and method of immobilization, weight-bearing status and timing of mobilization, ARRIVE-compliant reporting, and embedding of biological augmentation within defined management models are needed to strengthen translational value.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"160 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive assessment of the anaerobic threshold in endurance athletes: an evidence-based narrative review of methods, validity, and field feasibility.","authors":"Nicola Maffulli, Johnny Padulo, Francesco Oliva","doi":"10.1093/bmb/ldag037","DOIUrl":"10.1093/bmb/ldag037","url":null,"abstract":"<p><strong>Introduction or background: </strong>The anaerobic threshold (AnT) marks the transition between heavy and severe exercise intensity domains and guides training prescription and performance monitoring. Criterion methods (blood lactate and gas exchange) are accurate but invasive, costly, or impractical outside laboratories, prompting the search for noninvasive surrogates. This review evaluates the validity of these estimation procedures rather than the underlying physiology.</p><p><strong>Sources of data: </strong>MEDLINE (via PubMed) was searched from inception without language restrictions, supplemented by reference-list and citation searching. Eligible studies compared noninvasive AnT indices, including heart rate variability (HRV; including detrended fluctuation analysis [DFA] α1), cardiac repolarization instability, heart rate deflection/field slope-variation methods, critical power (CP)/ critical speed (CS), near-infrared spectroscopy (NIRS), the talk test, and machine-learning (ML) models, with criterion standards. Risk of bias was assessed using QUADAS-2. Eighty-eight reports were synthesized narratively; no meta-analysis was performed.</p><p><strong>Areas of agreement: </strong>DFA α1, NIRS breakpoints, and CP/CS show strong associations with laboratory criteria and increasing field applicability through wearables. Accuracy and feasibility trade-offs require method selection according to the threshold, sport, and required precision.</p><p><strong>Areas of controversy: </strong>Correlation indicates group-level association rather than individual agreement; Bland-Altman and reliability analyses are more informative for substitution. Criterion standards are not interchangeable, and heart rate deflection is not consistently identifiable. Evidence in female athletes remains limited.</p><p><strong>Growing points: </strong>Multimodal wearables integrating HRV, muscle oxygenation, and running power with ML may improve field-based threshold estimation.</p><p><strong>Areas for developing research: </strong>Priorities include standardized reporting, transparent bias assessment, female-athlete validation, and broader systematic and meta-analytic synthesis.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"160 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of long bone non-union with demineralized bone matrix: a systematic review.","authors":"Ryan N McIlwain, Elizabeth R Powell, Robin M Litten, Alexis N Alders, Joey P Johnson","doi":"10.1093/bmb/ldag040","DOIUrl":"https://doi.org/10.1093/bmb/ldag040","url":null,"abstract":"<p><strong>Background: </strong>Non-union is a challenging complication following long bone fractures. Demineralized bone matrix (DBM) has been increasingly utilized, however, its role in managing long bone non-union remains unclear. This systematic review evaluates the published research on the effectiveness of DBM in treating long bone non-union.</p><p><strong>Sources of data: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, Embase, and Scopus were searched from inception to March 2026 for studies assessing DBM use in adult long bone non-union.</p><p><strong>Areas of agreement: </strong>Eight studies including 340 patients were included. DBM was used alone or combined with autologous bone marrow concentrate (BMC), platelet-rich fibrin (PRF), platelet-rich plasma (PRP), or cancellous allograft chips. Union rates were similar when comparing DBM and iliac crest bone grafting (ICBG). DBM-treated patients achieved 79%-100% union (mean time to union between 3.7 and 11.9 months) versus 80%-100% for ICBG. Complications were minimally reported with no DBM-specific adverse events.</p><p><strong>Areas of controversy: </strong>Significant heterogeneity existed in DBM formulation, volume, and administration strategies. Studies utilized putty, strips, and injectable formulations, with volumes ranging 1-10 cc. DBM was also variably combined with PRP, BMC, or cancellous allograft chips. Outcome reporting was not standardized.</p><p><strong>Growing points: </strong>DBM appears to be an effective grafting strategy across diverse clinical applications and may offer a viable alternative to autologous grafting.</p><p><strong>Areas timely for developing research: </strong>Further high-quality randomized controlled trials with consistent outcome measures are needed to define optimal use of DBM in treating long bone non-union.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"160 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149294895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological factors as predictors of compliance and outcome in non-operative management of Achilles tendon rupture: a systematic review.","authors":"Nicola Maffulli, Filippo Spiezia","doi":"10.1093/bmb/ldag041","DOIUrl":"https://doi.org/10.1093/bmb/ldag041","url":null,"abstract":"<p><strong>Introduction: </strong>Non-operative management of acute Achilles tendon rupture (ATR) with early functional rehabilitation produces functional outcomes equivalent to surgery, but its effectiveness depends critically on patient compliance with bracing, weight-bearing and physiotherapy. Psychological factors, including motivation, self-efficacy, kinesiophobia, and social support, are plausible determinants of compliance and outcome, yet have received minimal systematic attention.</p><p><strong>Sources of data: </strong>Seven databases were searched from inception to June 2026 without language restriction. Studies of adults with ATR managed non-operatively, with any psychological assessment reporting compliance, re-rupture rate, Achilles Tendon Total Rupture Score (ATRS) or return to sport, were eligible. Six studies met the inclusion criteria (797 non-operative patients in total), and two further non-operative randomized controlled trials were used for functional benchmarking only. Data were synthesized narratively (SWiM framework).</p><p><strong>Areas of agreement: </strong>Non-operative management with early functional rehabilitation yields ATRS scores of 72-86 at 6-12 months, comparable to operative cohorts, with re-rupture rates of 5%-12% under functional bracing. Treatment success depends on patient compliance, and functional deficits persist for years irrespective of the management modality.</p><p><strong>Areas of controversy: </strong>Surgery continues to carry a lower re-rupture incidence than conservative management, although the absolute difference has narrowed with early functional rehabilitation. Whether pre-treatment psychological profiling should inform the choice between operative and non-operative management remains unvalidated, and no included study reported compliance as a formal outcome or its association with any psychological factor.</p><p><strong>Growing points: </strong>Kinesiophobia, anxiety, and depression are present throughout the first year of non-operative rehabilitation, and kinesiophobia scores above the clinical cut-off were observed in most participants of the only dedicated non-operative cohort. Kinesiophobia and readiness-to-return scores do not appear to differ between operatively and non-operatively managed patients, supporting a common psychological assessment framework. Qualitative evidence identifies motivation and social support as key facilitators of recovery.</p><p><strong>Areas timely for developing research: </strong>Future non-operative ATR randomized trials should incorporate the I-PRRS, TSK-11, and a validated motivation measure as pre-specified secondary outcomes, together with guideline-based compliance definitions. A prospective cohort study of baseline psychological profile as a predictor of compliance and re-rupture should be prioritized, followed by evaluation of simple psychological screening within consent and treatment-selection pathways.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"160 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149285339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tibial bone stress injury-a common cause of leg pain in sports.","authors":"Omar Najim, Ciaran Padhiar, Bashaar Aweid, Nat Padhiar, Osama Aweid","doi":"10.1093/bmb/ldag043","DOIUrl":"https://doi.org/10.1093/bmb/ldag043","url":null,"abstract":"<p><strong>Introduction: </strong>Tibial bone stress injuries (TBSI), encompassing tibial stress fractures (TSF) and medial tibial stress syndrome (MTSS), represent a significant spectrum of overuse pathology in active individuals, accounting for 22%-46% of sports-related stress injuries. These conditions feature distinct pathophysiological mechanisms and management pathways requiring precise diagnostic differentiation.</p><p><strong>Sources of data: </strong>Narrative review of primary and secondary literature sourced from PubMed and relevant clinical databases.</p><p><strong>Areas of agreement: </strong>Both conditions result from repetitive tibial loading without adequate rest and share overlapping risk factors. Management is primarily non-operative, with activity modification followed by graded rehabilitation. Magnetic resonance imaging (MRI) is the definitive imaging modality for TSF and is valuable in excluding differential diagnoses in MTSS.</p><p><strong>Areas of controversy: </strong>The utility of the Fredericson MRI grading system is debated. Certain intermediate grades may be clinically indistinguishable, and its prognostic value in paediatric populations is questioned. Furthermore, heterogeneous nomenclature used interchangeably impedes clear clinical communication.</p><p><strong>Growing points: </strong>Whether MTSS and TSF represent a shared pathological continuum or distinct clinical entities with overlapping risk factors remains unresolved, with histological evidence suggesting divergent pathophysiological mechanisms. Multicentre validation of MRI grading against functional outcomes and longitudinal studies evaluating early biomechanical interventions are key research priorities.</p><p><strong>Areas timely for developing research: </strong>Generalizability of evidence is limited by homogenous study populations and the absence of a universal return-to-sport definition. Priority must be given to establishing multidisciplinary consensus on nomenclature, diagnostic imaging thresholds, and risk-stratified rehabilitation protocols tailored to injury severity and comorbidities.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"160 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149318201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Popliteal artery entrapment syndrome. Current concepts, dilemmas, and challenges.","authors":"Laura Calsina-Juscafresa, Albert Clarà, Pedro Hinarejos, Oscar Gasulla, Salvatore Marsico, Joan Carles Monllau","doi":"10.1093/bmb/ldag034","DOIUrl":"https://doi.org/10.1093/bmb/ldag034","url":null,"abstract":"<p><strong>Introduction: </strong>Popliteal artery entrapment syndrome (PAES) results from extrinsic compression of the popliteal artery as it passes through the popliteal fossa due to congenital musculotendinous anomalies or acquired muscle hypertrophy. The consequence of this compression is a progressive damage to the arterial wall, which can ultimately cause irreversible injury. This damage initially manifests as intermittent claudication, which usually occurs in young, athletic individuals with no cardiovascular risk factors. There may be an overlap of symptoms with other conditions, making diagnosis challenging. Beyond clinical suspicion, dynamic tests with provocation manoeuvres are essential. Early decompression treatment of symptomatic cases can prevent the onset of potentially serious complications, including amputation.</p><p><strong>Sources of data: </strong>This review integrates evidence from peer-reviewed literature focusing on popliteal entrapment syndrome.</p><p><strong>Areas of agreement: </strong>Shortening the timeline from diagnosis to referral can help prevent irreversible damage to the arteries.There are a significant number of publications on PAES, based on retrospective single-centre experiences, short series or case reports, and limited scientific evidence. All publications repeatedly conclude that prospective multicentre studies are needed to standardize diagnostic and therapeutic protocols and develop guidelines for PAES.</p><p><strong>Areas of controversy: </strong>There are many points of disagreement regarding the management of PAES, and this does not help in addressing two key issues: avoiding misdiagnosis and unnecessary surgeries, which promote delayed diagnosis in worse clinical conditions.</p><p><strong>Growing points: </strong>The creation of multicentre working groups seems necessary due to the limited number of cases at individual centres for conducting prospective studies.</p><p><strong>Areas timely for developing research: </strong>Creation of international consensus protocols on definition, diagnosis, and treatment of PAES.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"160 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}