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Return to Play in Stress Fractures of the Hip, Thigh, Knee, and Leg

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Return to Play in Football

Abstract

A stress fracture results from abnormal loading or inadequate recovery time following repeated loadings on bony structures. Stress fractures occur after an increase in frequency, duration, or intensity of exercise creating imbalance between bone resorption and formation, most frequently affecting athletes and young people. Both intrinsic and extrinsic risk factors have been established. An estimated 90% of stress fractures in athletes and footballers affect the lower limb, with the tibia being the second most frequent injury site followed by the pelvis. Clinical history and physical examination are critical for early diagnosis and optimal treatment. Plain radiographs have low sensitivity and are often inadequate to detect this condition. The most frequent imaging exam is currently MRI, which has good sensitivity and specificity. Conservative treatment is an appropriate and effective treatment in most cases. High-risk fractures (e.g., involving high tension sites or hypovascular zones) often require surgical treatment to facilitate healing and reduce risk of refracture. Location of the fracture, characteristics of the fracture and the athlete, and the level of competition must be taken into account during treatment decision-making. There are no perfect imaging techniques nor clear clinical evidence-based guidelines concerning return to play. However, as a “golden rule,” the athlete should be symptom-free for 2–3 weeks before returning to the pitch. The fact that lower extremity stress fractures are relatively rare conditions creates increased difficulty in determining the effectiveness of treatments, particularly newer treatment options. This chapter provides a comprehensive management approach to stress fractures of the lower limb, with the exception of foot and ankle stress fractures, including the most updated information concerning optimal treatment and return to play.

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Author information

Authors and Affiliations

  1. 3B’s Research Group–Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017, Barco, Guimarães, Portugal

    Hélder Pereira, Joaquim Miguel Oliveira & Rui L. Reis

  2. ICVS/3B’s–PT Government Associate Laboratory, Braga, Guimarães, Portugal

    Hélder Pereira, Joaquim Miguel Oliveira & Rui L. Reis

  3. Orthopedic Department, Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal

    Hélder Pereira, Duarte Sousa & Joaquim Miguel Oliveira

  4. Ripoll y De Prado Sports Clinic—FIFA Medical Centre of Excellence, Murcia, Madrid, Spain

    Hélder Pereira, Joaquim Miguel Oliveira & Pedro L. Ripoll

  5. International Sports Traumatology Centre of Ave, Taipas Termal, Caldas das Taipas, Portugal

    Hélder Pereira, Sérgio Gomes & Joaquim Miguel Oliveira

  6. Dom Henrique Research Centre, Porto, Portugal

    Hélder Pereira & Joaquim Miguel Oliveira

  7. Department of Orthopaedic Surgery, ASPETAR Orthopaedic and Sports Medicine Hospital, Aspire Zone, Doha, Qatar

    Pieter d’Hooghe

  8. Clínica do Dragão, Espregueira-Mendes Sports Centre—FIFA Medical Centre of Excellence, Porto, Portugal

    Sérgio Gomes

  9. Dom Henrique Research Centre, Porto, Portugal

    João Espregueira-Mendes

  10. 3B’s Research Group–Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal

    João Espregueira-Mendes

  11. ICVS/3B’s–PT Government Associate Laboratory, Guimarães, Braga, Portugal

    João Espregueira-Mendes

  12. Department of Orthopaedic, Minho University, Braga, Portugal

    João Espregueira-Mendes

  13. Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Kenneth Hunt

Authors
  1. Hélder Pereira
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  2. Duarte Sousa
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  3. Pieter d’Hooghe
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  4. Sérgio Gomes
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  5. Joaquim Miguel Oliveira
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  6. Rui L. Reis
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  7. João Espregueira-Mendes
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  8. Pedro L. Ripoll
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  9. Kenneth Hunt
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Corresponding author

Correspondence to Hélder Pereira .

Editor information

Editors and Affiliations

  1. UPMC Rooney Sports Complex, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

    Volker Musahl

  2. Department of Orthopaedics, University of Gothenburg, Gothenburg, Sweden

    Jón Karlsson

  3. Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany

    Werner Krutsch

  4. Santa Monica, California, USA

    Bert R. Mandelbaum

  5. Clínica do Dragão, Espregueira-Mendes Sports Centre, Porto, Portugal

    João Espregueira-Mendes

  6. Orthopaedic Surgery, Aspetar Hospital, Doha, Qatar

    Pieter d'Hooghe

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Pereira, H. et al. (2018). Return to Play in Stress Fractures of the Hip, Thigh, Knee, and Leg. In: Musahl, V., Karlsson, J., Krutsch, W., Mandelbaum, B., Espregueira-Mendes, J., d'Hooghe, P. (eds) Return to Play in Football. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-55713-6_31

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  • DOI: https://doi.org/10.1007/978-3-662-55713-6_31

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  • Print ISBN: 978-3-662-55712-9

  • Online ISBN: 978-3-662-55713-6

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