Return to Sport After Proximal Hamstring Tendon Repair: A Systematic Review

Background: Previous studies have evaluated functional outcomes and return-to-sport rates after proximal hamstring tendon (HT) repair. Purpose: To systematically review the literature in an effort to evaluate return-to-sport rates after proximal HT repair. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify studies that evaluated postoperative lower extremity function and return-to-sport rates in patients after proximal HT repair. Search terms used were “hamstring,” “repair,” “return to sport,” and “return to play.” Patients were assessed based on return to sport, return to preinjury activity level, type of HT tear (complete or partial), and interval from injury to surgery. Patients were also divided into subgroups depending on timing of the surgical intervention: early, <1 month; delayed, 1 to 6 months; and late, >6 months from the time of injury. Results: Sixteen studies (one level 2, five level 3, ten level 4) met the inclusion criteria, including 374 patients with a complete proximal HT tear (CT group) and 93 patients with a partial proximal HT tear (PT group), with a mean follow-up of 2.9 years. Overall, 93.8% of patients (438/467) returned to sport, including 93.0% (348/374) in the CT group and 96.8% (90/93) in the PT group ( P = .18). The mean time to return to sport was 5.7 months, and 83.5% of patients (330/395) returned to their preinjury activity level. The early group demonstrated the greatest rate of return to sport at 94.4% (186/197) as well as the quickest time to return at a mean of 4.8 months, although this was not found to be statistically significant. Conclusion: Over 90% of patients undergoing repair of a complete or partial proximal HT tear can be expected to return to sport regardless of the tear type. Early surgical interventions of these injuries may be associated with a quicker return to sport, although the rate of return to sport does not differ based on timing of the surgical intervention.

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Return to Sport After ACL Reconstruction With a BTB Versus Hamstring Tendon Autograft: A Systematic Review and Meta-analysis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120964919 ◽

2020 ◽

Vol 8 (12) ◽

pp. 232596712096491

Author(s):

Matthew W. DeFazio ◽

Emily J. Curry ◽

Michael J. Gustin ◽

David C. Sing ◽

Hussein Abdul-Rassoul ◽

...

Keyword(s):

Systematic Review ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Meta Analysis ◽

Return To Sport ◽

Hamstring Tendon ◽

Cochrane Library ◽

Level Of Evidence ◽

Patient Reported ◽

Primary Acl Reconstruction

Background: Anterior cruciate ligament (ACL) tears are debilitating injuries frequently suffered by athletes. ACL reconstruction is indicated to restore knee stability and allow patients to return to prior levels of athletic performance. While existing literature suggests that patient-reported outcomes are similar between bone–patellar tendon–bone (BTB) and hamstring tendon (HT) autografts, there is less information comparing return-to-sport (RTS) rates between the 2 graft types. Purpose: To compare RTS rates among athletes undergoing primary ACL reconstruction using a BTB versus HT autograft. Study Design: Systematic review; Level of evidence, 4. Methods: The MEDLINE, Embase, and Cochrane Library databases were searched, and studies that reported on RTS after primary ACL reconstruction using a BTB or HT autograft were included. Studies that utilized ACL repair techniques, quadriceps tendon autografts, graft augmentation, double-bundle autografts, allografts, or revision ACL reconstruction were excluded. RTS information was extracted and analyzed from all included studies. Results: Included in the review were 20 articles investigating a total of 2348 athletes. The overall RTS rate in our cohort was 73.2%, with 48.9% returning to preinjury levels of performance and a rerupture rate of 2.4%. The overall RTS rate in patients after primary ACL reconstruction with a BTB autograft was 81.0%, with 50.0% of athletes returning to preinjury levels of performance and a rerupture rate of 2.2%. Patients after primary ACL reconstruction with an HT autograft had an overall RTS rate of 70.6%, with 48.5% of athletes returning to preinjury levels of performance and a rerupture rate of 2.5%. Conclusion: ACL reconstruction using BTB autografts demonstrated higher overall RTS rates when compared with HT autografts. However, BTB and HT autografts had similar rates of return to preinjury levels of performance and rerupture rates. Less than half of the athletes were able to return to preinjury sport levels after ACL reconstruction with either an HT or BTB autograft.

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Return to Sport After Ankle Syndesmotic Injury: A Systematic Review

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738118816282 ◽

2018 ◽

Vol 11 (2) ◽

pp. 116-122 ◽

Cited By ~ 1

Author(s):

Seline Y. Vancolen ◽

Ibrahim Nadeem ◽

Nolan S. Horner ◽

Herman Johal ◽

Bashar Alolabi ◽

...

Keyword(s):

Systematic Review ◽

Study Design ◽

Return To Sport ◽

Nonoperative Treatment ◽

High Rate ◽

Rate Of Return ◽

Syndesmotic Injury ◽

Level Of Evidence ◽

Treatment Groups ◽

Pertinent Data

Context: Ankle syndesmotic injuries present a significant challenge for athletes due to prolonged disability and recovery periods. The optimal management of these injuries and rates of return to sport in athletes remains unclear. Objective: The purpose of this study was to evaluate return to sport for athletes after ankle syndesmotic injuries. Data Source: The electronic databases MEDLINE, EMBASE, and PubMed were searched for relevant studies from database inception to January 15, 2017, and pertinent data were abstracted. Study Selection: Only studies reporting return-to-sport rates after ankle syndesmotic injuries were included. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Two reviewers extracted data from the included studies, which were stored in a standardized collection form (Microsoft Excel). Recorded data included demographics (eg, author, year of publication, study design), descriptive statistics (eg, patient age, percentage male, number of athletes, sample size), and outcomes (eg, time to return to sport, proportion of those who returned to sport, the self-reported questionnaire the Olerud-Molander Ankle Score). Results: A total of 10 studies and 312 patients with ankle syndesmotic injuries were included in this systematic review. The rate of return to preinjury or any injury level of sport after ankle syndesmotic injuries was 93.8% ± 1.2% and 97.6% ± 1.5%, respectively, for the corresponding 7 and 3 studies that reported this characteristic. The mean time to return to sport was 46.4 days (range, 15.4-70 days), with 55.2 ± 15.8 and 41.7 ± 9.8 days for operative and nonoperative management, respectively. Conclusion: This systematic review found a high rate of return to any as well as preinjury level of sport after ankle syndesmotic injury in both operative and nonoperative treatment groups. However, further high-level studies are required to compare operative and nonoperative treatment groups associated with return to sport after ankle syndesmotic injury.

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Return to Sport after Anatomic and Reverse Total Shoulder Arthroplasty in Elderly Patients: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm9051576 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1576

Author(s):

Rocco Papalia ◽

Mauro Ciuffreda ◽

Erika Albo ◽

Chiara De Andreis ◽

Lorenzo Alirio Diaz Balzani ◽

...

Keyword(s):

Systematic Review ◽

Elderly Patients ◽

Shoulder Arthroplasty ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Total Shoulder Arthroplasty ◽

Case Series ◽

Return To Sport ◽

Rate Of Return ◽

Cochrane Library

The aim of this systematic review and meta-analysis was to evaluate the rate of return to sport in elderly patients who underwent anatomic (ATSA) and reverse (RTSA) total shoulder arthroplasty, to assess postoperative pain and functional outcomes and to give an overview of postoperative rehabilitation protocols. A systematic search in Pubmed-Medline, Cochrane Library, and Google Scholar was carried out to identify eligible randomized clinical trials, observational studies, or case series that evaluated the rate of return to sport after RTSA or ATSA. Six retrospective studies, five case series, and one prospective cohort study were included in this review. The overall rate of return to sport was 82% (95% CI 0.76–0.88, p < 0.01). Patients undergoing ATSA returned at a higher rate (90%) (95% CI 0.80–0.99, p < 0.01) compared to RTSA (77%) (95% CI 0.69–0.85, p < 0.01). Moreover, the results showed that patients returned to sport at the same or a higher level in 75% of cases. Swimming had the highest rate of return (84%), followed by fitness (77%), golf (77%), and tennis (69%). Thus, RTSA and ATSA are effective to guarantee a significative rate of return to sport in elderly patients. A slightly higher rate was found for the anatomic implant.

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Return to Sport After Coracoid Transfer in Athletes With Anterior Shoulder Instability: A Systematic Review

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738119853825 ◽

2019 ◽

Vol 11 (5) ◽

pp. 402-408

Author(s):

Georgina Glogovac ◽

Adam P. Schumaier ◽

Brian M. Grawe

Keyword(s):

Systematic Review ◽

Shoulder Instability ◽

Return To Sport ◽

Patient Reported Outcome ◽

Rate Of Return ◽

Anterior Shoulder Instability ◽

Level Of Evidence ◽

Coracoid Transfer ◽

Patient Reported

Context: Recurrent shoulder instability in young athletes can lead to a spectrum of soft tissue and bony lesions that can be bothersome and/or disabling. Coracoid transfer is a treatment option for athletes with recurrent instability. Objective: To report the rate of return to sport for athletes after coracoid transfer. Data Sources: An electronic search of the literature was performed using the PubMed (MEDLINE) and Cochrane Databases (1966-2018). Study Selection: Studies were included if they evaluated return to sport after treatment with coracoid transfer at a minimum 1-year follow-up. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Data were extracted by 2 authors and included study design, level of evidence, patient demographics (number, age, sex), procedure performed, duration of clinical follow-up, rate of return to sport, patient-reported outcome measures, reoperations, and complications. Results: Fourteen studies met the inclusion criteria. The rate of return to sport at any level ranged from 80% to 100% in all but 1 study (38%), and the rate of return to the previous level of play ranged from 56% to 95% in all but 1 study (16%). Patients returned to sport at an average of 3.2 to 8.1 months. The average patient-reported outcome scores ranged from 78% to 94% (Rowe), 223.6 to 534.3 (Western Ontario Shoulder Instability Index), and 75% to 90% (subjective shoulder value). The rate of postoperative dislocation ranged from 0% to 14%, and the reoperation rate ranged from 1.4% to 13%. Conclusion: There was a high early rate of return to sport in patients who underwent coracoid transfer for anterior shoulder instability, although patients did not reliably return to the same level of play. The procedure had very favorable outcomes for treatment of instability, with low rates of recurrent dislocation and reoperation.

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Return to Sport After Surgical Treatment for Anterior Shoulder Instability: A Systematic Review

The American Journal of Sports Medicine ◽

10.1177/0363546518780934 ◽

2018 ◽

Vol 47 (6) ◽

pp. 1507-1515 ◽

Cited By ~ 19

Author(s):

Hussein Abdul-Rassoul ◽

Joseph W. Galvin ◽

Emily J. Curry ◽

Jason Simon ◽

Xinning Li

Keyword(s):

Systematic Review ◽

Shoulder Instability ◽

Return To Sport ◽

Activity Level ◽

Rate Of Return ◽

Anterior Shoulder Instability ◽

Activity Levels ◽

Shoulder Stabilization ◽

Successful Recovery ◽

Arthroscopic Latarjet

Background: For athletes, a return to preinjury activity levels with minimal time away is a metric indicative of successful recovery. The knowledge of this metric would be helpful for the sports medicine specialist to advise patients on appropriate expectations after surgery. Purpose: To evaluate the rate and amount of time needed for athletes to return to sport (RTS) after different surgical treatments for anterior shoulder instability. Study Design: Systematic review and meta-analysis. Methods: The MEDLINE, EMBASE, and Cochrane databases were searched for articles relevant to athletes’ RTS after surgical anterior shoulder stabilization with variants of the Latarjet and Bankart procedures. Article selection was based on relevant inclusion and exclusion criteria. After the articles were reviewed, the data pertinent to rates of and time to RTS were extracted, compiled, and analyzed. Results: Sixteen articles met the inclusion criteria. Based on these articles, the rate of RTS was 97.5% after arthroscopic Bankart, 86.1% after open Bankart, 83.6% after open Latarjet, 94.0% after arthroscopic Latarjet, and 95.5% after arthroscopic Bankart with remplissage. Among the athletes who did RTS, arthroscopic Bankart had the highest rate of return to preinjury levels (91.5%), while arthroscopic Latarjet had the lowest rate (69.0%). The time to RTS was 5.9 months after arthroscopic Bankart, 8.2 months after open Bankart, 5.07 months after open Latarjet, 5.86 months after arthroscopic Latarjet, and 7 months after arthroscopic Bankart with remplissage. Conclusion: Of the pooled data, patients who underwent arthroscopic Bankart showed the highest rate of RTS, while patients who underwent open Latarjet showed the shortest time to RTS. Return to preinjury level was highest in the arthroscopic Bankart group and lowest in the arthroscopic Latarjet group. Physicians can utilize these data to set expectations for their patient-athletes regarding RTS after anterior shoulder stabilization procedures. Clinical Relevance: When treating an athlete, many factors must be taken into account to weigh treatment options. Two important factors to consider with the patient-athlete are the rate of return to the previous activity level and the timeline for this to occur. This study provides a guide for physicians and a time frame for athletes with respect to the mean percentage and time for return to sport after different surgical procedures for anterior shoulder instability.

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Return to Play After Revision Anterior Shoulder Stabilization: A Systematic Review

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120982059 ◽

2021 ◽

Vol 9 (3) ◽

pp. 232596712098205

Author(s):

Brian C. Lau ◽

Lorena Bejarano Pineda ◽

Tyler R. Johnston ◽

Bonnie P. Gregory ◽

Mark Wu ◽

...

Keyword(s):

Systematic Review ◽

Return To Play ◽

Rate Of Return ◽

Bone Block ◽

Complication Rates ◽

Weighted Mean ◽

Shoulder Stabilization ◽

Level Of Evidence ◽

Patient Goals ◽

Open Stabilization

Background: Revision shoulder stabilizations are becoming increasingly common. Returning to play after revision shoulder stabilizations is important to patients. Purpose: To evaluate the return-to-play rate after revision anterior shoulder stabilization using arthroscopic, open, coracoid transfer, or free bone block procedures. Study Design: Systematic review; Level of evidence, 4. Methods: All English-language studies published between 2000 and 2020 that reported on return to play after revision anterior shoulder stabilization were reviewed. Clinical outcomes that were evaluated included rate of overall return to play, level of return to play, and time to return to play. Study quality was evaluated using the Downs and Black quality assessment score. Results: Eighteen studies (1 level 2; 17 level 4; mean Downs and Black score, 10.1/31) on revision anterior shoulder stabilization reported on return to play and met inclusion criteria (7 arthroscopic, 5 open, 3 Latarjet, and 3 bony augmentation), with a total of 564 revision cases (mean age, 27.9 years; 84.1% male). The weighted mean length of follow-up was 52.5 months. The overall weighted rate of return to play was 80.1%. The weighted mean rate of return to play was 84.0% (n = 153) after arthroscopic revision, 91.5% (n = 153) after open revision, 88.1% (n = 149) after Latarjet, and 73.8% (n = 65) after bone augmentation. The weighted mean rate of return to same level of play was 69.7% for arthroscopic revision, 70.0% for open revision, 67.1% for Latarjet revision, and 61.8% after bone block revision. There were 5 studies that reported on time to return to play, with a weighted mean of 7.75 months (4 arthroscopic) and 5.2 months (1 Latarjet). The weighted mean rates of complication (for studies that provided it) were 3.3% after arthroscopic revision (n = 174), 3.5% after open revision (n = 110), 9.3% after Latarjet revision (n = 108), and 45.8% after bone block revision (n = 72). Conclusion: Revision using open stabilization demonstrated the highest return-to-play rate. Revision using Latarjet had the quickest time to return to play but had higher complication rates. When evaluated for return to same level of play, arthroscopic, open, and Latarjet had similar rates, and bone block had lower rates. The choice of an optimal revision shoulder stabilization technique, however, depends on patient goals. Higher-quality studies are needed to compare treatments regarding return to play after revision shoulder stabilization.

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Surgical Outcomes of Inguinal-, Pubic-, and Adductor-Related Chronic Pain in Athletes: A Systematic Review Based on Surgical Technique

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211023116 ◽

2021 ◽

Vol 9 (9) ◽

pp. 232596712110231

Author(s):

Munif Hatem ◽

RobRoy L. Martin ◽

Srino Bharam

Keyword(s):

Systematic Review ◽

Surgical Treatment ◽

Surgical Technique ◽

Return To Sport ◽

Pubic Symphysis ◽

Ice Hockey ◽

Return To Play ◽

Chronic Groin Pain ◽

Level Of Evidence ◽

Duration Of Symptoms

Background: Controversies remain regarding the surgical treatment of inguinal-, pubic-, and adductor-related chronic groin pain (CGP) in athletes. Purpose: To investigate the outcomes of surgery for CGP in athletes based on surgical technique and anatomic area addressed. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed and Embase databases were searched for articles reporting surgical treatment of inguinal-, pubic-, or adductor-related CGP in athletes. Inclusion criteria were level 1 to 4 evidence, mean patient age >15 years, and results presented as return-to-sport, pain, or functional outcomes. Quality assessment was performed with the CONSORT (Consolidated Standards of Reporting Trials) statement or MINORS (Methodological Index for Non-randomized Studies) criteria. Techniques were grouped as inguinal, adductor origin, pubic symphysis, combined inguinal and adductor, combined pubic symphysis and adductor, or mixed. Results: Overall, 47 studies published between 1991 and 2020 were included. There were 2737 patients (94% male) with a mean age at surgery of 27.8 years (range, 12-65 years). The mean duration of symptoms was 13.1 months (range, 0.3-144 months). The most frequent sport involved was soccer (71%), followed by rugby (7%), Australian football (5%), and ice hockey (4%). Of the 47 articles reviewed, 44 were classified as level 4 evidence, 1 study was classified as level 3, and 2 randomized controlled trials were classified as level 1b. The quality of the observational studies improved modestly with time, with a mean MINORS score of 6 for articles published between 1991 and 2000, 6.53 for articles published from 2001 to 2010, and 6.9 for articles published from 2011 to 2020. Return to play at preinjury or higher level was observed in 92% (95% CI, 88%-95%) of the athletes after surgery to the inguinal area, 75% (95% CI, 57%-89%) after surgery to the adductor origin, 84% (95% CI, 47%-100%) after surgery to the pubic symphysis, and 89% (95% CI, 70%-99%) after combined surgery in the inguinal and adductor origin. Conclusion: Return to play at preinjury or higher level was more likely after surgery for inguinal-related CGP (92%) versus adductor-related CGP (75%). However, the majority of studies reviewed were methodologically of low quality owing to the lack of comparison groups.

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Outcomes and Return to Sport After Pectoralis Major Tendon Repair: A Systematic Review

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738118818060 ◽

2018 ◽

Vol 11 (2) ◽

pp. 134-141 ◽

Cited By ~ 4

Author(s):

James Yu ◽

Cindy Zhang ◽

Nolan Horner ◽

Olufemi R. Ayeni ◽

Timothy Leroux ◽

...

Keyword(s):

Systematic Review ◽

Pain Relief ◽

Clinical Outcomes ◽

Tendon Repair ◽

Surgical Techniques ◽

Return To Sport ◽

Pectoralis Major ◽

High Rate ◽

Rate Of Return ◽

Level Of Evidence

Context: Pectoralis major tendon ruptures are becoming increasingly common due to the growing prevalence of active lifestyles. Studies investigating the efficacy of pectoralis major tendon repair have limited sample sizes and offer mixed results, while existing reviews do not explore postoperative activity outcomes for patients. Objective: To summarize and synthesize the clinical outcomes and rate of return to activity after isolated pectoralis major tendon repair. Data Sources: Four databases (MEDLINE, EMBASE, PubMed, and CINAHL) were searched from database inception through March 7, 2018. Study Selection: Studies reporting outcomes of isolated pectoralis major tendon repair for pectoralis major tendon rupture were included. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Data including patient demographics, intervention details, and clinical outcomes were extracted. The methodological quality of included studies was evaluated. Results: Of 2332 retrieved articles, 18 studies were included, with a total of 536 patients. A majority (90%; 134/149) of patients undergoing pectoralis major tendon repair successfully returned to sport at a mean 6.1 ± 1.7 months postsurgery, of which 74% (95/128) successfully returned to their preinjury level of sport. The majority (95%; 269/284) of patients returned to work at a mean 6.9 ± 1 months. Postsurgically, 81% (83/102) of patients experienced complete pain relief after the surgery, and 19% (21/109) had cosmetic complaints after pectoralis major repair. Of the 10 studies that reported complications, 18% (75/423) of patients had postoperative complications, including reruptures and wound infections; 7% (30/423) of patients required reoperation for their complications. Conclusion: Pectoralis major tendon repair is an effective treatment that results in a high rate of return to sport and work, pain relief, and improved cosmetic appearance, albeit with a significant rate of complication. The evidence supporting all outcomes was limited by the rarity of the injury, the variable surgical techniques, and outcome assessment criteria.

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Return to Play After Medial Patellofemoral Ligament Reconstruction: A Systematic Review

The American Journal of Sports Medicine ◽

10.1177/0363546520947044 ◽

2020 ◽

pp. 036354652094704

Author(s):

Amit K. Manjunath ◽

Eoghan T. Hurley ◽

Laith M. Jazrawi ◽

Eric J. Strauss

Keyword(s):

Systematic Review ◽

Patellar Instability ◽

Medial Patellofemoral Ligament ◽

Mpfl Reconstruction ◽

Return To Play ◽

Rate Of Return ◽

Cochrane Library ◽

Inclusion Criteria ◽

Recurrent Instability ◽

Recurrent Patellar Instability

Background: Medial patellofemoral ligament (MPFL) reconstruction is being performed more frequently in athletes experiencing recurrent patellar instability. Purpose/Hypothesis: The purpose was to systematically review the evidence in the orthopaedic sports medicine literature to determine both the rate and timing of return to play after MPFL reconstruction and the rate of further patellar instability. Our hypothesis was that there would be a high rate of return to play after MPFL reconstruction. Study Design: Systematic review. Methods: A systematic literature search was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, which utilized EMBASE, MEDLINE, and the Cochrane Library databases. Inclusion criteria for literature included clinical studies reporting on return to play after MPFL reconstruction. Rate of return to play, level of return, timing of return, rate of recurrent instability, and patient-reported outcomes were evaluated. Statistical analysis was performed using SPSS. Results: Our review found 27 studies including 1278 patients meeting our inclusion criteria. The majority of patients were women (58%), and the total group had a mean age of 22.0 years and a mean follow-up of 39.3 months. The overall rate of return to play was 85.1%, with 68.3% returning to the same level of play. The average time to return to play was 7.0 months postoperatively. The rate of recurrent instability events following reconstruction was 5.4%. There was an improvement in both mean visual analog scale, pain scores (preoperative: 4.3, postoperative: 1.6) and Tegner activity scores (preoperative: 4.8, postoperative: 5.5). Conclusion: The overall rate of return to play was high after MPFL reconstruction for the treatment of recurrent patellar instability. However, a relatively high percentage of those patients were unable to return to their preoperative level of sport. Additionally, there was a moderate time taken to return to play, at approximately 7 months after the procedure.

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The Treatment and Outcomes of Medial Malleolar Stress Fractures

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738114546089 ◽

2014 ◽

Vol 6 (6) ◽

pp. 527-530 ◽

Cited By ~ 9

Author(s):

Val Irion ◽

Timothy L. Miller ◽

Christopher C. Kaeding

Keyword(s):

Stress Fracture ◽

Treatment Options ◽

Case Series ◽

Return To Sport ◽

Stress Fractures ◽

Return To Play ◽

Cochrane Library ◽

Medial Malleolus ◽

Retrospective Case ◽

Level Of Evidence

Context: The medial malleolus is considered a high-risk stress fracture and can be debilitating to the highly active or athletic populations. A range of treatment methods have been described with varying outcomes. Currently, there is no gold standard treatment option with optimal results described. Objective: A systematic search of the literature to determine treatment options and outcomes in medial malleolus stress fractures. Data Sources: OVID/Medline, EMBASE, and the Cochrane Library from 1950 to September 2013. Study Selection: Included studies mentioned treatment and outcomes of medial malleolus stress fractures. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: The searches used combinations of the terms stress fracture, medial malleolus, management, and treatment. Two authors independently reviewed the selected articles and created individual tables, which were later compiled into a master table for final analysis. Results: Six retrospective case series were identified (n = 31 patients). Eighty percent (25/31) of patients were men, with an average age of 24.5 years. Ninety percent (28/31) of patients were at least involved in recreational athletics. All patients were able to return to sport. Complications were seen in both groups ranging from minor stiffness to nonunion requiring open reduction internal fixation. Conclusion: Nonoperative and operative interventions have proven to be successful with regard to healing and return to play for medial malleolar stress fractures in the recreational and competitive athlete. However, early operative intervention can possibly create a higher likelihood of early healing, decrease in symptoms, and return to play.

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