Introduction Knee osteoarthritis (OA) is characterized by pain and functional deficits. Common conservative strategies include medications, physical therapy, and intra‐articular injections. Recently, treatment using autologous cell injections has increased. Objective To characterize the cellular content of bone marrow aspirate (BMA) and to evaluate the effect of intra‐articular autologous BMA injections in patients with mild knee OA. Design Prospective pilot observational study. Setting Academic institution. Patients Eleven patients with unilateral or bilateral mild knee OA (15 knees) were included in the cellular analysis. Ten patients (13 knees) were included in the overall (cellular and clinical) analysis. Interventions BMA was aspirated from patients’ iliac crests and then injected intra‐articularly under fluoroscopic and/or ultrasound guidance. BMA samples were analyzed using flow cytometry, colony forming unit (CFU) assays, and enzyme‐linked immunosorbent assays. Questionnaires assessing pain and function were administered preinjection and at 1, 3, 6, and 12 months postinjection. Side effects and satisfaction were assessed. Main Outcome Measures Total nucleated cell (TNC) concentration, mesenchymal stem cell (MSC) concentration, CFU count, and interleukin‐1 receptor antagonist (IL‐1Ra) concentration. Results BMA sample analyses revealed wide ranges in TNC concentration (173300‐4 491 050 cells/mL), MSC concentration (0‐500 cells/mL), CFUs (0‐19), and IL‐1Ra concentration (2806‐29 394 pg/mL). Improvements in Knee Injury and Osteoarthritis Outcomes Score for Joint Replacement were observed throughout the 12‐month follow‐up period (F[4,12] = 12.29, P < .001). Additionally, current, usual, best, and worst numerical rating scale pain scores significantly decreased over time (P < .001). Patient satisfaction was high (range: 8.1 ± 2.1‐8.8 ± 1.9), and side effects were uncommon. Conclusions The cellular content of BMA samples varied widely between patients and was lower than the anticipated yield reported by the device's manufacturer. However, intra‐articular BMA injections for knee OA in a small pilot cohort appeared to be safe with potential therapeutic value. Larger, prospective, double‐blinded studies are warranted.

Objective:To compare the efficacy of ultrasound-guided hyaluronic acid (HA) versus leukocyte-poor platelet-rich plasma (LP-PRP) injection in the treatment of glenohumeral osteoarthritis.Design:Double-blind randomized controlled trial.Setting:Academic institution.Patients:Seventy patients with chronic glenohumeral osteoarthritis were randomly assigned to receive a single injection of HA (n = 36) or LP-PRP (n = 34).Interventions:Leukocyte-poor platelet-rich plasma was processed using Harvest/TerumoBCT Clear PRP kits. Ultrasound-guided injections of 6 mL HA or 6 mL LP-PRP into the glenohumeral joint were performed. Patients, the injecting physician, and outcomes assessor were blinded to treatment assignments.Main outcome measures:Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) score, current/average numerical rating scale (NRS) pain scores, satisfaction, and side effects were assessed at the 5 follow-up time points over 12 months.Results:Baseline characteristics were similar between groups. There were no significant between-group differences regarding SPADI, ASES, and current/average NRS pain scores at any time point up to 12 months postinjection (P > 0.05). However, significant improvements in SPADI, ASES, and current/average NRS pain scores were observed in both groups starting at 1 or 2 months (P < 0.01, P < 0.01, P < 0.001, and P < 0.01, respectively). These improvements were observed regardless of osteoarthritis severity. For patients who received LP-PRP, there was no effect of platelet yield on outcomes. Side effect and satisfaction rates were similar between groups.Conclusions:There were no differences in pain and functional outcomes after a single injection of LP-PRP versus HA. However, significant improvements in pain and function were observed after both treatments in patients with glenohumeral osteoarthritis.

Background: Diastasis rectus abdominis (DRA) is characterized by a widening between the rectus abdominis muscles and thinning of the linea alba. It is common during pregnancy and may contribute to postpartum low back pain (LBP) and stress urinary incontinence (SUI). Core strengthening is thought to improve DRA, but there is no widely accepted exercise program. Objectives: To assess changes in interrectus distance (IRD) and participant-reported outcomes (PROs) after an online core strengthening program in postpartum women with DRA. Study Design: Prospective observational study. Methods: Forty-three postpartum women (36.7 ± 3.5 years) with DRA, which was diagnosed as an IRD 2.0 cm or more using musculoskeletal ultrasound, participated in a 12-week online core strengthening program focused on daily transversus abdominis activation with coordinated breathing and pelvic floor muscle engagement. IRD and PROs were assessed at baseline and 12 weeks. A subset of 19 women participated in an additional 12-week maintenance phase, and outcomes assessments were performed at 24 weeks. Results: The 12-week online core strengthening program significantly decreased IRD above and below the umbilicus at rest (slope [95% confidence interval]: −0.56 [−0.74, −0.38] and −0.26 [−0.45, −0.06]; P < .001 and P = .009, respectively) and below the umbilicus during contraction (−0.39 [−0.58, −0.20]; P < .001). Improvements in LBP-related disability (P = .002) and SUI (P = .001) were also observed. Participation in the maintenance phase significantly improved IRD at 24 weeks compared with 12 weeks (P < .0125). Satisfaction averaged 7.43 ± 2.23. Conclusions: The 12-week online core strengthening program reduced IRD and improved LBP-related disability and SUI. Program participation for 12 additional weeks further reduced IRD. These results suggest that the online core strengthening program can be used in postpartum women with DRA.

Background Menstrual irregularity (MI) is common in female athletes and is a component of the Female Athlete Triad (Triad). Many athletes with the Triad are started on hormonal contraceptives (HC) for MI, but this interferes with the ability to monitor menstrual cycle regularity and can mask other causes of MI. There are limited studies investigating the relationship between MI, HC use, and injury in female collegiate athletes. Objective To examine the prevalence of and relationship between HC use, MI, and bone stress injuries in female collegiate athletes in the United States. Design Cross‐sectional study. Setting Online survey. Participants 1020 U.S. female collegiate athletes (age ≥ 18 years). Methods or Interventions Assessment of risk factors for menstrual irregularity and bone stress injuries was conducted via a one‐time survey. Main Outcome Measures HC use, MI, history of stress fractures. Results Current HC use prevalence was 65% (95% confidence interval [CI], 61.9%, 67.8%). Of all athletes, 47% reported past MI. Of the athletes who were not currently using HCs, 32% had current MI. Compared with athletes without past MI, more athletes with past MI reported current HC use (73% vs. 57%) and indicated menstrual cycle consistency as the primary reason for use (24% vs. 4%) (P < .001). Additionally, 25% of athletes reported a history of stress fractures, which was associated with lean/aesthetic sports participation (odds ratio [95% CI]: 1.9 [1.4, 2.5]; P < .001) and less oral contraceptive pill (OCP) use (0.7 [0.5, 1.0]; P = .043). Compared with OCPs, injectable HCs were associated with greater odds of a history of stress fractures (4.5[1.6, 12.3]; P = .004). Conclusions HC use was prevalent among this cohort of female collegiate athletes, and almost half of the athletes reported past MI. A goal of menstrual cycle regularity was cited by 24% of athletes as a primary reason to use HCs, which shows that more athlete education is needed to avoid masking MI and the Triad with HCs. Further studies elucidating the relationship between HC use, MI, and sports‐related injury are warranted.

Background: Achilles injury risk in women’s collegiate gymnastics is 10-fold higher than in all other collegiate sports. This study aims to identify risk factors for Achilles tendon ruptures in collegiate female gymnasts. Hypothesis: Gymnasts with Achilles tendon ruptures will be more likely to report early gymnastics specialization, elite-level training before college, and performance of high-difficulty skills on floor and vault. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: Anonymous surveys were distributed to current and former collegiate female gymnasts, aged 18 to 30 years, via coaches, athletic trainers, Twitter, and ResearchMatch. Information about Achilles tendon ruptures, gymnastics-related injuries, sport specialization, event/skills participation, and medication use were collected. Results: A total of 581 gymnasts were included. One hundred gymnasts (17.2%; 95% CI: 14.1%-20.3%) reported Achilles tendon ruptures during collegiate training or competition. Most ruptures (91%) occurred on floor exercise; 85.7% of these occurred during back tumbling-take-off. Compared with gymnasts without ruptures during college, a greater percentage of gymnasts with ruptures competed at a Division I program, trained elite, competed difficult vaults and floor passes before and during college, competed in all 4 events during college, identified as Black/African American, and used retinoid medications. Conclusion: Achilles tendon ruptures are more common in women’s collegiate gymnastics than other sports. Competing at the elite level, performing difficult floor and vault skills, and competing in all 4 events may increase the risk for an Achilles tendon rupture. Potential nontraining risk factors include retinoid exposure and Black/African American race. Future studies regarding the mechanisms of Achilles tendon ruptures in female collegiate gymnasts are warranted. Clinical Relevance: Collegiate gymnasts who compete at the elite level, perform high levels of difficulty on floor and vault, and compete in all 4 events may be at increased risk for Achilles tendon ruptures.