Context The physical nature of rugby is responsible for the high incidence of injuries, but no researchers have examined the epidemiology of injuries sustained by elite under-18 rugby players. Objective To investigate the incidence of injuries sustained by players on the Spanish national under-18 rugby team during their participation in 4 European championships (2014–2017) and the types of play in which they occurred. Design Cohort study. Setting European rugby championships. Patients or Other Participants Ninety-eight under-18 rugby players. Main Outcome Measure(s) All injuries sustained during the championship periods were recorded per the World Rugby protocol. Results A total of 40 injuries were logged over the 4 championships. The incidence of injury was higher during matches than during training (P < .05), with 138.0 (95% confidence interval [CI] = 136.5, 139.6) injuries per 1000 hours of play compared with 1.2 (95% CI = 1.2, 1.3) per 1000 hours of training. With only 2 days of rest between games, the injury rate was higher than with 3 days of rest (P < .05). More injuries were sustained during the third quarter of the game: 13 (44.8%) versus 6 (20.6%) in the last quarter, 5 (17.3%) in the second quarter, and 5 (17.3%) in the first quarter. Conclusions The most common injuries during matches were sprains and concussions, and these injuries were more likely to occur during matches than during training. Most injuries were caused by tackles and occurred during the third quarter of the game. These findings indicate that teams should focus on teaching players skills to reduce injuries caused by tackles and warming up properly before returning to the field after halftime. The injury rate was higher with only 2 versus 3 days' rest between games. These results suggest that young players' matches should be at least 72 hours apart.

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Background:The clinical evaluation of the patient with shoulder instability can be challenging. The pathological spectrum ranges from the straightforward “recurrent anterior dislocation” patient to the overhead athlete with a painful shoulder but not clear instability episodes. Advances in shoulder arthroscopy and imaging have helped in understanding the anatomy and physiopathology of the symptoms. The aim of this general article is to summarize the main examination manoeuvres that could be included in an overall approach to a patient with a suspicion of instability.Material and Methods:In order to achieve the above-mentioned objective, a thorough review of the literature has been performed. Data regarding sensibility and specificity of each test have been included as well as a detailed description of the indications to perform them. Also, the most frequent and recent variations of these diagnostic tests are included.Results:Laxity and instability should be considered separately. For anterior instability, a combination of apprehension, relocation and release tests provide great specificity. On the other hand, multidirectional or posterior instability can be difficult to diagnose especially when the main complain is pain.Conclusion:A detailed interview and clinical examination of the patient are mandatory in order to identify a shoulder instability problem. Range of motion of both shoulders, clicking of catching sensations as well as pain, should be considered together with dislocation and subluxation episodes. Specific instability and hyperlaxity tests should be also performed to obtain an accurate diagnosis.

Synovial chondromatosis of the shoulder is a rare disorder characterized by metaplastic synovial proliferation, causing multiple loose bodies usually localized intra-articularly. Surgical treatment with open techniques through a deltopectoral approach has been commonly used. The evolution of arthroscopy has allowed a complete joint assessment and the extraction of intra-articular loose bodies with less morbidity than open techniques. Nevertheless, this pathology occurs less frequently in the subcoracoid bursa. Access to this bursa may be more complicated when extracting loose bodies that cause pain and functional limitation in performing activities of daily living. We describe an arthroscopic and endoscopic technique for the treatment of subcoracoid synovial chondromatosis through a medial transpectoral portal, allowing safe loose body extraction under direct visualization around the coracoid process and brachial plexus. The literature was reviewed, and benefits of this endoscopic technique were analyzed.

A double-bundle anterior cruciate ligament (ACL) reconstruction associated with an anterolateral ligament (ALL) reconstructions is performed. The semitendinosus and gracilis are harvested. At knee maximum flexion, the anteromedial (AM) femoral tunnel is performed in the AM footprint area. Through the anterolateral portal, the tip of the outside-in femoral guide is placed in the posterolateral footprint area. The guide sleeve is pushed onto the lateral femoral cortex at the ALL attachment. At 110° knee flexion, the posterolateral-ALL tunnel is performed. The tibial ACL tunnel is performed as usual. The tibial guide is placed between the ALL tibial attachment and the tibial ACL tunnel entrance to perform the ALL tibial tunnel. The gracilis graft is introduced from caudal to cranial, achieving fixation with a 6-mm diameter screw (outside-in). The AM femoral fixation is achieved with a suspension device. ACL tibial graft fixation is achieved with a screw. Afterward, the gracilis is passed under the fascia lata to the tibial entry point. A 6-mm diameter screw is placed from the external cortex into the tibial ALL tunnel. The biomechanical advantage of the double-bundle ACL reconstruction with the biomechanical advantage of the ALL anatomic reconstruction is achieved.