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In 1955, Professor Mianyu Qu, the founder of Chinese sports medicine, and the older generation of sports medicine practitioners, founded China's sports medicine in response to the needs of the development of national sports and health. In the first 30 years of the establishment of sports medicine, they played an important role in the academic development, talent cultivation, international communication, construction of the society and organization, national Olympic glory, and national fitness. Their contributions established a solid foundation for the rapid development of China's sports medicine in the following 30 years. With the country's emphasis and support for the discipline of sports medicine, in 1996, the Institute of Sports Medicine of Peking University became the only national "211 Project" key discipline. In 2013, the National Health Commission of China established the national key clinical specialty, the Institute of Sports Medicine of Peking University, and other four institutions were included. In 2019, the National Development and Reform Commission, the National Health Commission, the National Administration of Traditional Chinese Medicine, and the Secretariat of the State Council Medical Reform Leading Group promoted the construction of a national regional medical center; the Chongli Campus of Peking University Third Hospital became the only national sports trauma regional medical center. Meanwhile, with the successful hosting of the 2008 Beijing Summer Olympics and the 2022 Beijing Winter Olympics, as well as the implementation of the 2035 China Science and Technology Development Plan and the Healthy China Strategy, the sports medicine in China has encountered great opportunities for rapid and vigorous development in the past 30 years. Construction and Development of Academic Organizations of Sports Medicine In the past 30 years, the construction and development of academic organizations of sports medicine was an important foundation for the rapid development of sports medicine, especially after the successful bidding and hosting of the 2008 Beijing Summer Olympics. At the same time, China held a world-wide sports science conference before the hosting of the Beijing Summer Olympics, namely, the 2008 Olympic Science Conference, in accordance with the requirements of the International Olympic Organizing Committee and international practices. This provided a great opportunity for the construction of academic organizations in sports medicine. In 2005, in order to support the Beijing Olympics, accelerate the development of sports medicine in China, and better serve the people's health, Professor Mianyu Qu, Changlong Yu, and Yingfang Ao from the Institute of Sports Medicine of Peking University, and Professor Tianle Yang, Guoping Li, and Jinhua Qian from China National Institute of Sports Medicine as the founders submitted an application for the establishment of a new specialized society to the Chinese Medical Association. In April 2007, the Chinese Society of Sports Medicine was founded in Beijing. Professor Guoping Li as the first founding president, Professor Changlong Yu was the president-elect, Professor Yingfang Ao was the vice president and secretary general. From then on, the development of sports medicine in China ushered in a new spring. With the successful bidding and hosting of the 2022 Beijing Winter Olympics, there are new opportunities for the development of sports medicine in China. In order to ensure medical security for the Winter Olympics and serve the national ice and snow strategy, Chinese Sports Medicine Physicians Association under the umbrella of Chinese Medical Doctor Association was established in Beijing in May 2019, Professor Yingfang Ao was the founding president. So far, the Chinese Medical Association, the Chinese Medical Doctor Association, and the China Sport Science Society are driving and leading the construction and development of sports medicine academic organizations in China. Together with the sports medicine branches of other associations, as well as the sports medicine organizations of local medical associations and physician associations, they have made important contributions to promoting the rapid development of sports medicine in China. Interdisciplinary Intersection and Special Medicine Characteristics of Sports Medicine and Main Tasks Modern sports medicine is an interdisciplinary subject that combines medical science, sports science, and related modern disciplines. It mainly uses the basic principles and technical methods of medicine, combined with the relevant theories and techniques of natural sciences, to study human physiological functions, pathophysiological changes, and treatment of sports injuries under the conditions of sports, exercise training, lack of exercise, and excessive exercise. Sports medicine belongs to the first-level discipline of the medical category and the second-level discipline under special medicine in the national discipline classification (with independent master and doctoral-granting points), and is also a separate clinical diagnosis and treatment subject set by the National Health Commission (code 22).1 In clinical practice, sports medicine mainly combines theories, methods, and techniques from multiple disciplines such as surgery, internal medicine, traditional medicine, rehabilitation medicine, and imaging to prevent, treat, and recover sports injuries. It scientifically guides sports fitness and training, enhances physical fitness, ensures athletes' athletic performance and competitive ability, and promotes population health. In clinical practice, sports medicine mainly includes four professional fields: sports trauma, medical supervision, sports nutrition, and sports rehabilitation. The research tasks include: investigating how to enhance human physical fitness through physical exercise, promoting health through reasonable and effective exercise, delaying aging, treating chronic diseases, and providing a scientific theoretical basis. Sports medicine utilizes various modern medical scientific methods to evaluate the training level of athletes, ensuring that they undergo reasonable training, promoting the rapid elimination of fatigue, preventing excessive fatigue, thus maximizing sports performance, and improving sports technical level. Clinical Research Progress of Sports Medicine in China Modern arthroscopic minimally invasive surgery technology was applied in the clinical treatment of sports trauma. It has opened a precedent in the treatment of sports medicine injuries in China, which is a milestone development. In the past 30 years, the development and application of modern arthroscopic equipment and surgical instruments dedicated to bone and joint injuries, have played an important role in the diagnosis and treatment of joint injuries. This completely changed the stage of the endoscope from its first application in the late 1970s and early 1980s. Using an arthroscope, comprehensive diagnosis, minimally invasive treatment, and accurate reconstruction surgery for intra-articular structures and injuries could be performed. This avoided the adverse effects caused by traditional open surgery, such as large invasiveness, long surgery time, imprecise repair, slow rehabilitation, and poor prognosis. At present, arthroscopic minimally invasive surgery mainly focused on the diagnosis and treatment of shoulder, elbow, hip, knee, ankle, and small joint injuries, or even some extra-articular injuries. In the past 30 years, some key advances in minimally invasive arthroscopic therapy have been made by Chinese scholars, such as cruciate ligament reconstruction, joint instability treatment, and cartilage repair treatment. For anterior cruciate ligament reconstruction (ACLR), Chinese scholars first carried out ACLR using the elliptic bone tunnel in the world, followed by the development of adjustable round-rectangular bone tunnel reconstruction based on anatomical biomechanics,2 which changed the traditional concept of ACLR and significantly improved knee joint anteromedial rotational instability. For shoulder anterior dislocation, Chinese scholars introduced the "mortise and tenon" structure of ancient Chinese architecture into the classic Bristow surgery. They invented an arthroscopically improved "Inlay" coracoid transfer surgery, known as Chinese Unique Inlay Bristow (CUIstow) surgery. This procedure significantly promoted bone integration by increasing bone contact area, thus increasing the stability of the transferred coracoid bone graft.3 The modified elastic fixation Latarjet surgery under arthroscope was developed for the treatment of chronic clavicular anterior dislocation of the shoulder.4 For ankle instability, a new tarsal transverse talar tunnel reconstruction technique was developed to reconstruct the anterior tarsal fibular ligament, which significantly reduced the vascular injury rate and improved surgical safety.5 For hip injury, arthroscopic autologous iliotibial band transplantation was used to repair acetabular labrum injury. For cartilage repair, the cell-free scaffold was developed and applied to repair cartilage under arthroscopy. Moreover, the "Guidelines for the Repair and Reconstruction of Knee Cartilage Injury" was developed. Basic and Translational Research of Sports Medicine in China Basic research Cartilage repair has achieved an increasing attention. Chinese scholars have used different strategies such as tissue engineering and gene therapy to repair cartilage and have made remarkable progress. A structurally and functionally optimized scaffold was designed by integrating silk fibroin with gelatin in combination with bone marrow-derived mesenchymal stem cells (BMSC)-specific affinity peptide.6 The combination ratio of silk fibroin and gelatin greatly balanced the mechanical properties and degradation rate to match the newly formed cartilage. The addition of BMSC-specific affinity peptide promoted the recruitment of stem cells to the cartilage defect, thus accelerating cartilage regeneration. The tissue repair using exosomes has become a hot topic in the field of sports medicine recently. Studies have shown that exosomes from adipose tissue-derived mesenchymal stem cells (MSCs) were more robust in promoting migration, proliferation, and chondrogenesis of stem cells.7 Within the last decade, biological 3D printing has made significant progress, especially in tissue engineering and regenerative medicine. 3D bioprinting could manufacture biomaterial scaffolds with precise microstructures and macroshapes, simulating the natural environment of the human body, thereby promoting cell growth and tissue regeneration. Chinese scholars produced a new type of dynamic hydrogel regulated by host–guest cross-linking using 3D bioprinting, which could support cells and promote bone and cartilage regeneration.8 For meniscus repair, acellular meniscus extracellular matrix (ECM) and demineralized cancellous bone scaffolds demonstrated good results in meniscus repair.9 Biomechanical and biochemical stimuli were applied to MSCs implanted in biomimetic scaffolds to spatially regulate fibrochondrogenesis and achieve anisotropic reconstruction of the meniscus.10 Another scholar developed 3D-bioprinted anisotropic biomimetic meniscus scaffold with cellular phenotype and ECM deposition patterns, which not only restored the anisotropy of native meniscus, but better maintained joint function and prevented secondary joint degeneration.11 In order to recruit endogenous stem cells for regeneration, the stem cell-specific affinity peptide was combined with silk fibroin and polycaprolactone complex multispace meniscus scaffold to create a favorable microenvironment for stem cell proliferation, differentiation, and ECM generation.12 Osteoarthritis (OA) was a pervasive degenerative joint disease that caused a serious challenge to global health. Domestic scholars were continuously studying the pathogenesis of OA and investigating new therapeutic targets. The critical role of non-coding RNA in the pathogenesis of OA was clarified. The chondrocyte ECM metabolism-related circular RNA (circRNA-CER) acted as a "sponge" for miR-136, which controlled matrix metalloproteinase 13 (MMP13) expression, thus facilitating ECM degradation. Additionally, the mechanically stress-related circular RNA (circRNA-MSR) and long non-coding RNA (lncRNA-MSR) were involved in the ECM degradation process of chondrocytes, which could be the target for alleviating OA.13,14 The small molecule drugs were developed to delay OA progression. The novel small molecule compound BNTA was developed to enhance chondrocyte synthesis metabolism by increasing SOD3 activity and catalyzing the dismutation of superoxide anions.15 The cholesterol low-density lipoprotein receptor-related protein 3 (LRP3)-syndecan-4 axis was clarified to cause OA. The LRP3 gene therapy may alleviate OA.16 Furthermore, the specific peroxisome proliferator-activated receptor γ (PPARγ) inhibitor 5aza could inhibit DnMT1 and DnMT3a, which in turn, reversed the hypermethylation of PPARγ promoters associated with excessive inflammatory responses in OA, thereby delaying the progression of OA.17 Tendon-bone healing was a significant clinical challenge. The unique structure of the tendon-bone insertion site, a transitional region encompassing bone, fibrocartilage, and tendon, complicated the restoration of physiological gradient tissue structure after injury. An organic-inorganic flexible fiber membrane was created by electrospinning technology.18 Histological and biomechanical evaluations indicated efficient glycosaminoglycan synthesis, proper collagen fiber alignment, and satisfactory load-bearing capacity and strength. In addition, the bioactive factors were applied in tendon bone healing. For example, a composite hydrogel was developed as an active drug delivery system for promoting healing of the rotator cuff tendon-to-bone interface.19 For tendon repair, a system that nitric oxide-loaded metal–organic frameworks encapsulated in polycaprolactone/gelatin-aligned coaxial scaffolds was designed and prepared for tendon repair. This system demonstrates slow and stable release of nitric oxide, promoting tubular formation of endothelial cells in vitro and increasing blood perfusion near the injured tendon in vivo.20 Apart from functional materials, the BMSCs-derived exosomes were demonstrated to promote the proliferation, migration, and tenogenic differentiation of tendon stem/progenitor cells, thus facilitating tendon repair.21 Translational research As an in-depth understanding of disease pathogenesis and regenerative process, Chinese scholars emphasized translational research based on clinical practice. The new concept of "autologous, in situ and one-step" cartilage repair was proposed by Chinese scholars. The cortical bone decalcification scaffold was used to recruit BMSCs to form a stem cell niche to repair large articular cartilage defects.22 A new minimal invasive method and rehabilitation strategy for the repair of articular cartilage injury by acellular and decalcified bone matrix under arthroscope were established. The clinical ten-year follow-up showed satisfactory results. In addition, the minimal invasive, safe autologous peripheral blood stem cell isolation and culture system was developed, which expanded the source of tissue repair cells. This system was suitable for clinical promotion and application. The multicenter clinical study was carried out to repair cartilage and meniscus injuries using autologous peripheral blood stem cell transplantation. For the aforementioned adjustable round-rectangular bone tunnel ACLR, customized medical equipment was developed. For the aforementioned CUIstow surgery, the proprietary medical equipment was developed for modified "Inlay" coracoid transfer surgery and applied in the clinic. Interdisciplinary Research In recent years, the scope of sports medicine research has gradually expanded, manifesting as an increase in cross-disciplinary research across multiple fields, disciplines, and specialties. The advancement of human motion measurement technology, portability, and computer simulation technology has increased the depth and dimension of research on sports injuries. With the vigorous development of national fitness and ice and snow sports, the research field of sports medicine in China has also delved into clinical respiratory, circulatory, neurological systems, and so on. The implementation of the national major "Science and Technology Winter Olympics Special Project" fully reflected the importance of interdisciplinary development in sports medicine. Rehabilitation and Exercise Promotes Health The rehabilitation of sports injuries plays an important role in the treatment of injuries. The team of Professor Yingfang Ao has established a comprehensive evaluation system for skeletal muscle system function, exploring the changes in exercise patterns of injured patients from multiple aspects such as muscle function, kinematics, dynamics, and foot contact to guide rehabilitation training. "Sports is Medicine" is an international hotspot. The deep integration of national fitness and national health is an important development direction in China. Significant progress has been made in promoting health through exercise, and the development of exercise prescriptions combined with physical education and medicine has played an important role in providing evidence-based exercise and health guidance for the general population (adults and the elderly). It has played a positive and effective role in the prevention, treatment, and rehabilitation of common chronic diseases among the population. At the same time, research on the mechanisms of promoting health and preventing chronic diseases through exercise continues to deepen. Yang et al23 has revealed that running can reduce the inflammatory response of chondrocytes through the adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK)/nuclear factor kappaB (NF-κB) signaling pathway, thereby alleviating the progression of OA. In addition, Chinese scholars have revealed that running can reverse the tumor immune cold microenvironment of non-small cell lung cancer by inhibiting squalene epoxidase, transforming the tumor immune cold microenvironment into an immune hot microenvironment, thereby achieving anticancer effects.24 Medical Security for Major National Sports Events Since the 11th Asian Games held in Beijing in 1990, the Chinese sports medicine team has provided medical service for large-scale comprehensive sports events. During the 29th Summer Olympics in Beijing in 2008, a medical support team led by the Institute of Sports Medicine of Peking University entered various venues and achieved significant achievements in the prevention, treatment, and rehabilitation of sports injuries, demonstrating the important position of Chinese sports medicine in the medical support of international competitive sports. During the 2022 Beijing Winter Olympics, the Chinese sports medicine medical team went deep into the frontline, leveraging technology to serve the Winter Olympics. Establishing a medical information command platform, equipped with rescue helicopters, onboard panoramic cameras, medical information collection terminals, intelligent electrocardiogram and ultrasound transportation, emergency mobile tablets, and other emergency equipment combined with the 5G medical security technology service system to achieve a perfect combination of medical treatment and technology, and safeguard the hosting of a simple, safe, and exciting Winter Olympics. At the same time, the Chinese medical team has won high recognition from the International Olympic Organizing Committee for their exquisite medical technology, high-quality medical services, rapid transportation and treatment, demonstrating China's medical support capabilities for large-scale sports medicine events to the world. Moreover, based on the summary of scientific evidence, clinical practice experience, and medical treatment experience at the 2022 Winter Olympics, Chinese scholars have developed the "Expert Consensus on the Treatment Process of Snow Sports Trauma," which provided scientific suggestions for establishing an efficient treatment network that integrates prehospital rescue, in-hospital emergency treatment, and in-hospital specialized treatment, and has been recognized by international peers. Prospects Chinese sports medicine has encountered new development opportunities in the key period of China's mid to long-term planning and development toward 2035, and in the strategic goal of building a world innovative power. We will definitely make great progress in adhering to the principles of integrity, innovation, and development based on our previous work. In terms of injury prevention and rehabilitation, the focus is on researching new theories, technologies, methods, and models applicable to the fields of sports system injuries, sports-related diseases of other systems, sports rehabilitation, and sports prevention and treatment of degeneration and aging. Modern high-tech technologies such as artificial intelligence, digital medicine, biological therapy, and robotics should be fully utilized to improve the clinical level of treatment for sports injuries and degenerative diseases, to accelerate the transformation, implementation, promotion, and application of sports technology, and to achieve high-level development of sports medicine discipline and technology. In the aspect of promoting active health, we will open up new fields for exercise promoting health, and explore a new model of "exercise promotes health" and "health first integrating prevention, treatment, rehabilitation, and health care." It will make new contributions to promoting the transformation from medical security to health security, improving national health, and realizing of "Healthy China" national strategy.
Ao et al. (Tue,) studied this question.