Purpose Video gamers exceeding screen-time limits are at greater risk of experiencing health issues associated with physical inactivity. Demonstrating that exercise has positive effects on video game performance could promote physical activity among video gamers. We investigated the short-term effects of a single session of cardiovascular exercise on the performance of the popular video game League of Legends (LoL) and explored psychosocial mechanisms. Methods Twenty young video gamers played a customized LoL task preceded by a short bout of high-intensity interval training or a period of rest. The two conditions were administered on two separate days in a randomized counterbalanced fashion. Video game performance was assessed as the total number of targets eliminated as well as accuracy, defined as the ability to eliminate targets using single attacks. Short-term changes in affect after exercise as well as exercise enjoyment were also assessed. Results Exercise improved (P = 0.027) the capacity to eliminate targets (mean ± SEM, 121.17 ± 3.78) compared with rest (111.38 ± 3.43). Exercise also enhanced accuracy (P = 0.019), with fewer targets eliminated with more than one attack after exercise (1.39 ± 0.39) compared with rest (2.44 ± 0.51). Exercise increased positive affect by 17% (P = 0.007), but neither affect nor exercise enjoyment was associated with total number of targets eliminated or accuracy. Conclusion A short bout of intense cardiovascular exercise before playing LoL improves video game performance. More studies are needed to establish whether these effects are generalizable to other video games, whether repeated bouts have summative effects, and to identify underlying mechanisms.

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Background: Conservative management is the first line of treatment in most osteochondritis dissecans (OCD) cases and can be sufficient for small and stable lesions in skeletally immature patients. Unstable lesions commonly require surgical interventions and may need fixation. The standard surgical approach to fix posteromedial lesions of the talus involves an osteotomy of the medial malleolus. This technique is invasive and requires multiple weeks of immobilization after the surgery. In this video, we present a minimally invasive transmalleolar approach used for the fixation of an OCD lesion of the talus. Indications: The main indication for this procedure is the failure of conservative management with persistent ankle pain and functional impairment of an unstable osteochondral lesion with poor potential for revascularization. Technique Description: There are 3 key steps to this surgery: ankle arthroscopy, retroarticular drilling, and transmalleolar fixation. The transmalleolar approach is achieved by creating a tunnel through the medial malleoli oriented toward the lesion. To do so, the surgeon combines fluoroscopy and ankle arthroscopy to first insert a Kirschner wire (K-wire) through the medial malleoli. Once the correct orientation is confirmed, a 4.5-mm cannulated drill bit is used to create the tunnel. Arthroscopic visualization is used to avoid iatrogenic cartilage damage during drilling. Once the tunnel is created, ankle dorsiflexion and plantar flexion are used to access the entire lesion and insert screws. The malleolar tunnel is then filled with a bone graft and the wound closed. The patient is immobilized for 2 weeks after which gentle range of motion is initiated. The patient remains non-weight-bearing for 2 months and is then allowed to bear weight using a boot. Results: Transmalleolar fixation for osteochondritis dissecans of the talus is a minimally invasive procedure that does not require an osteotomy of the medial talus. This approach permits early postoperative range of motion and decreases postoperative pain and edema, but the adequate positioning of the tunnel can prove challenging. Conclusion: Transmalleolar approach to the talus is minimally invasive and allows adequate fixation of certain osteochondral lesions. Studies comparing the reoperation and complication rate with the standard malleolar osteotomy are lacking and need to be performed. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Background: The onset of COVID-19 coincided with the peak growth of video game usage with 2.7 billion gamers in 2020. During the pandemic, gaming and streaming platforms offered an entertaining, social, and safe alternative to recreation during severe lockdowns and social isolations. This study aimed to examine the impact of the COVID-19 pandemic on health-related outcomes in self-proclaimed video gamers based on the type of lockdown experienced, and to discuss the potential role of video games during times of preventive lockdown measures. Methods: This was a cross-sectional international survey constructed by two academic institutions NYIT (NY; USA); McGill University, (Montreal, Canada) and Adamas Esports (BC, Canada). The survey consisted of questions including demographics, multiple-choice, rating, and Likert scales relating to prior and during the COVID-19 lockdowns. Respondents included 897 replies from North America (72.7%), Europe (10.9%), Asia (4.9%) and other countries (11.5%) mean age 22 years. Results: Significant increases in game time were reported in casual and competitive gamers during the first months of the pandemic. Level of gaming, type of lockdown, and physical activity level prior to the pandemic were examined as potential moderating factors. Significant increases in sedentary behaviors (video game time and sitting time) were observed, while physical activity levels remained unchanged in most participants regardless of the type of lockdown. Sleep time, but not sleep quality, increased, while mental health exhibited opposing effects, influenced by the type of lockdown and gaming competition levels. Conclusions:Video games, when played moderately, could offer a cost-effective, safe strategy to promote socialization, mental health, and improve the overall well-being of the non-gaming and gaming population during pandemic times when strict lockdowns are in place.