Introduction: Injury and illness rates within cycling are a growing concern for riders, medical personnel, and event organisers. This study is the first to document injury and illness rates in professional cyclists throughout one competitive season including training and racing. 
Methods: A prospective, longitudinal study was conducted with 47 professional cyclists (30 males and 17 females) over the 2024 season (1 November 2023-31 October 2024). Injuries and illnesses were defined and recorded following the International Olympic Committee (IOC) consensus guidelines for injury reporting in sports and its cycling-specific extension. Data collection utilised a centralised online hub, integrating exposure metrics (e.g., training hours and kilometres) and medical records. All data were processed on a Macintosh computer using the Microsoft Office and R statistics packages epi tools, binom.test function, and ggplot. (V.4.3.2, R Foundation for Statistical Computing, Vienna, Austria). Ethical approval was obtained from Queens University Belfast, number MHLS 23_175. 
Results: Fifty-five injury events were logged, with 1.15 (±0.359) locations injured per incidence and 1.57 (±1.06) injury types per incident. The overall combined injury rate for racing was 4.14 (95% CI: 2.65-5.79) per 1000 h of exposure, with the overall combined rate for training being 1.23 (95% CI: 0.8-1.7) per 1000 h. The injury risk ratio (RR) for injury during racing and training for females was 11.10 (95% CI: 2.69-37.60), and the RR for males was 10.24 (95% CI: 3.84-43.06), both indicating there is a significantly higher risk of injury during racing compared to training. Abrasions were the most common injury type, with fractures being the most burdensome injury. The most common illness was upper respiratory, 0.63 (95% CI: 0.27-0.99) per year for males and 1.11 (95% CI: 0.64-1.59) per year for females. Saddle sores were the second most common at 0.20 (95% CI: 0.04, 0.36) per year for males and 0.08 (95% CI: 0-0.18) per year for females. 
Conclusions: This study provides the first comprehensive, season-long surveillance data for injuries and illnesses in male and female professional road cycling, highlighting the significant differences in injury profiles between racing and training. These results underscore the need for targeted injury prevention strategies and the establishment of a standardised injury and illness framework for professional cycling.

Background: External iliac artery endofibrosis (EIAE) is an uncommon pathology, predominantly occurring in cyclists, caused by thickening of the external iliac artery intima. Symptoms are exercise-dependent and typically consist of pain, muscle cramps and loss of strength in the affected limb at (sub)maximal effort. As other musculo-skeletal as well as conditional problems might cause similar complaints diagnosis is not always easy or straightforward.

Case summary and discussion: We reviewed four cases of (semi-)professional cyclists referred to our department in 2021 because of suspicion of EIAE. In all symptoms only occurred at (sub)maximal effort. All had lowering of ABI on the affected side at a dynamic stress test on the bike. Imaging using CTA, MRA or dynamic angiogram was abnormal in all patients, showing signs suspicious for endofibrosis but of different kind and at different locations. Open surgical repair was performed in all cases by a procedure tailored to the type of lesion. Two patients were treated by a saphenous vein patch angioplasty, in one patient a shortening of the vessel and end-to-end anastomosis was performed and in the fourth patient a spiral saphenous vein graft bypass was placed. Postoperative course was uneventful and exercise was resumed after four weeks in all patients.

Conclusion: Correct diagnosis is essential in the treatment of EIAE. A complete and multidisciplinary pathway should be followed to distinguish vascular from non-vascular causes. Correct lesion localization is crucial and besides CTA or MRA, more sophisticated techniques such as dynamic angiography or intravascular ultrasound might be needed.

Background: Flow limitations in the iliac arteries (FLIA) is a sport-related vascular condition increasingly recognised as an occupational risk for professional cyclists and other endurance athletes. Surgical reconstruction is the definitive treatment for athletes wishing to continue competition. However, less information has been published regarding conservative management options and return-to-sport (RTS) guidelines.

Objective: Our aim was to review the existing literature on conservative treatment of FLIA, identify knowledge gaps and propose an RTS framework for athletes returning to competition.

Methods: A comprehensive literature review was performed using the Ovid-MEDLINE, PubMed, Embase and PEDro databases for publications relevant to conservative management of FLIA. A scoping review was conducted following PRISMA-ScR guidelines. Original, peer-reviewed publications in English describing conservative or postoperative management for athletes with FLIA were included. Additional grey literature and clinical expertise were consulted to inform RTS guidelines.

Results: Overall, 62 studies were included in this review. In total, 11 categories of conservative modalities were extracted and presented qualitatively in terms of the information source (discussion or results statements) and perspective of the authors (positive, negative or mixed). We have proposed RTS guidelines covering pre-operative preparation and postoperative rehabilitation based on the available literature, clinical experience, and drawing from other areas of sports medicine research.

Conclusion: There is insufficient literature evaluating the effectiveness of conservative management options for FLIA to establish best practices. Considering the importance of RTS for competitive athletes, we proposed practical guidelines to help with clinician and patient decision making. Future consensus should be sought for RTS best practices.

Hintergrund: Die iliakale Endofibrose (IE) ist eine seltene arterielle Erkrankung bei Ausdauerathleten, insbesondere Radrennfahrern und Triathleten. Die Diagnostik gilt als Herausforderung, die Latenz vom Beginn erster Symptome bis zur Diagnosestellung beträgt oft mehrere Jahre. An diagnostischen Möglichkeiten sind die Bestimmung des Knöchel-Arm-Dopplerindex (ankle brachial index, ABI) nach maximaler Belastung als ein nicht invasives Verfahren sowie die Duplexsonografie, Schichtbildgebung und die invasive Angiografie zu nennen. Ziel dieser Arbeit ist es, diese zeitliche Verzögerung bis zur korrekten Diagnosestellung seit Erstbeschreibung im Jahr 1985 bis zum Jahr 2021 genauer zu analysieren sowie die wichtigsten diagnostischen Mittel für die Praxis herauszuarbeiten.

Methode: Durchführung einer Literaturrecherche gemäß den PRISMA-Kriterien in den Datenbanken PubMed, Web of Science und Cochrane, ergänzt durch eine Suche in Google Scholar bis zum 18.10.2021.

Ergebnisse: Es wurden 133 Publikationen identifiziert, die sich thematisch mit der IE bei Ausdauersportlern beschäftigten. In 42 Publikationen (40 Fallberichte und 2 klinische Studien) wurde die Diagnose intraoperativ bestätigt, in 32 (32/43; 74,4%) wurden Aussagen über die Dauer vom Auftreten der ersten Symptome bis zur Diagnosestellung gemacht (Mittelwert 45, Median 36 Monate). Diese Latenz war über den gesamten Beobachtungszeitraum von 1985–2021 konstant, ohne Trend zur Verkürzung. In 24 Arbeiten (24/43; 56%) wurde detailliert über Ergebnisse der ABI-Bestimmung sowie der weiterführenden Diagnostik berichtet. In allen Fällen kam es zu einem Abfall des ABI- Wertes auf weniger als 0,66 (in 5 Fallberichten bereits in Ruhe, in 19 nach Belastung), wohingegen die weiterführende Diagnostik mittels Duplexsonografie, DSA, MRA oder CTA in 3 Fällen (3/24; 12,5%) keinen auffälligen Befund ergab und in 14 Fällen (14/24; 58,3%) eine allenfalls geringgradige Stenosierung zeigte.

Schlussfolgerung: Ein Abfall des ABI nach Belastung ist die zuverlässigste Methode, um die iliakale Endofibrose zu diagnostizieren. Es empfiehlt sich, diese nicht invasive und einfach durchführbare Untersuchung in die Leistungsdiagnostik gefährdeter hochambitionierter Ausdauerathleten zu integrieren, um im Idealfall durch eine frühzeitige Diagnosestellung irreversible Gefäßwandschäden zu verhindern sowie die vermutete hohe Dunkelziffer an unerkannten Fällen zu reduzieren.