When Can Surgically Treated Medial Malleolar Stress Fractures Return to Sport?

Researchers took a closer look at medial malleolar stress fractures treated with surgery and how this impacted return-to-sport in elite athletes.¹ They analyzed 6 cases of medial malleolar stress fracture in 5 athletic individuals. These patients underwent surgical intervention, with a step-wise approach based on characteristics of the fracture line. In this pathway, surgeons first debrided bony spurs arthroscopically, then performed microfracture of the fracture line, and lastly, screw fixation.¹

As far as evaluating return-to-sport, the researchers collected data on return to training in their specific sport, return to normal training practices, return to competition, and various performance metrics.¹ They found that specialty training commenced at a median of 10 weeks postop, whereas they resumed their typical training regimen at about 16 weeks postoperatively. By 19 weeks, they had returned to competitive sport. Each patient underwent stage 1 of the procedure, with removal of the bony spurs. Four patients had the second step, involving the microfracturing, and 3 received screw fixation.¹

All of the patients studied went on to clinical and radiographic union, as seen on 3 month postop computed tomography (CT). The researchers related no refracture, hardware issues, or other complications in their cohort.¹

Overall, the authors propose a customized approach to each case using these surgical steps, using the sagittal plane fracture line for guidance. They also acknowledge that although many athletes will return to competitive sport by 4 months postop, self-reported full recovery to desired performance levels can be more prolonged.¹

Reference
1.     Ramsodit KR, Zwiers R, Dalmau-Pastor M, Gouttebarge V, Kerkhoffs GMMJ. Most elite athletes return to preinjury competitive activity after surgical treatment for medial malleolus stress fractures. Knee Surg Sports Traumatol Arthrosc. 2024 Jun 3. doi: 10.1002/ksa.12284. Epub ahead of print. PMID: 38829266.