Background:Few studies have documented expected time to return to athletic participation
after stress fractures in elite athletes.Hypothesis:Time to return to athletic participation after stress fractures would vary by
site and severity of stress fracture.Study Design:Retrospective cohort study.Level of Evidence:Level 3.Methods:All stress fractures diagnosed in a single Division I collegiate men’s and
women’s track and field/cross-country team were recorded over a 3-year
period. Site and severity of injury were graded based on Kaeding-Miller
classification system for stress fractures. Time to return to full
unrestricted athletic participation was recorded for each athlete and
correlated with patient sex and site and severity grade of injury.Results:Fifty-seven stress fractures were diagnosed in 38 athletes (mean age, 20.48
years; range, 18-23 years). Ten athletes sustained recurrent or multiple
stress fractures. Thirty-seven injuries occurred in women and 20 in men.
Thirty-three stress fractures occurred in the tibia, 10 occurred in the
second through fourth metatarsals, 3 occurred in the fifth metatarsal, 6 in
the tarsal bones (2 navicular), 2 in the femur, and 5 in the pelvis. There
were 31 grade II stress fractures, 11 grade III stress fractures, and 2
grade V stress fractures (in the same patient). Mean time to return to
unrestricted sport participation was 12.9 ± 5.2 weeks (range, 6-27 weeks).
No significant differences in time to return were noted based on injury
location or whether stress fracture was grade II or III.Conclusion:The expected time to return to full unrestricted athletic participation after
diagnosis of a stress fracture is 12 to 13 weeks for all injury sites.Clinical Relevance:Athletes with grade V (nonunion) stress fractures may require more time to
return to sport.
Background: The best operative construct and technique for treatment of isolated syndesmotic injuries is highly debated. The purpose of this study was to determine whether the addition of anterior inferior tibiofibular ligament (AITFL) suture repair or suture tape (ST) augmentation provides any biomechanical advantage to the operative repair of an isolated syndesmotic injury. Methods: Twelve lower leg specimens underwent biomechanical testing in 6 states: (1) intact, (2) AITFL suture repair, (3) AITFL suture repair + transsyndesmotic suture button (SB), (4) AITFL suture repair + ST augmentation + SB, (5) AITFL suture repair + ST augmentation, and (6) complete syndesmotic injury. The ankle joint was subjected to 6 cycles of 5 Nm internal and external rotation torque under a constant axial load. The spatial relationship between the tibia, fibula, and talus was continuously recorded with a 5-camera motion capture system. Results: AITFL suture repair and AITFL suture repair + ST augmentation showed no statistically significant change in fibula kinematics compared to the intact state. Compared to native, AITFL suture repair + SB showed increased fibular external rotation (+2.32 degrees, P < .001), and decreased tibiofibular gap (overtightening) (–0.72 mm, P = .007). AITFL suture repair + ST augmentation + SB also showed increased fibular external rotation (+1.46 degrees, P = .013). Sagittal plane motion of the fibula was not significantly different between any states. None of the repairs restored intact state talus rotation; however, the repairs that used ST augmentation reduced the talus external rotation laxity compared to the complete syndesmotic injury. Conclusion: AITFL suture repair and AITFL ST augmentation best restored the rotational kinematics and stability of the fibula and ankle joint in an isolated syndesmotic injury model. Clinical Relevance: AITFL suture repair with or without ST augmentation may be a good operative addition or alternative to SB fixation for isolated syndesmotic disruptions.
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