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Stress fractures of the medial malleolus in the professional soccer player treated with open reduction & internal fixation with arthroscopic spur debridement
ESSKA Academy. Calder J. Nov 8, 2019; 286360
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Stress fractures of the medial malleolus in the professional soccer player treated with open reduction & internal fixation with arthroscopic spur debridement

AFAS Free Papers

Topic: Arthroscopy

Calder J.1, Nguyen A.2, Beasley I.3
1Imperial College, London, United Kingdom, 2Royal Adelaide Hospital, Adelaide, Australia, 3Queen Mary College, London, United Kingdom

Introductions: Despite a debilitating effect on athletic performance and an incidence of up to 4% of all stress fractures, there have been only 31 documented cases of medial malleolus stress fractures (MMSF) to our knowledge in the literature. The largest series to date is presented in this study, of 16 professional soccer players undergoing uniform operative treatment.
Objectives: To critically analyse outcomes of treatment for MMSFs in the professional soccer player, with an emphasis on patient satisfaction, clinical and radiographic union, and return to high level sport.
Aims:
1 - To establish a gold standard of treatment for MMSFs in athletes, with an emphasis on patient satisfaction, clinical and radiographic union, and return to high level sport.

2 - To prove an association between lower limb varus alignment and the development of MMSFs.

Methods: Sixteen professional soccer players of mean age 23.6 years were analysed. A biomechanic assessment was performed. Preoperative CT+-MRI scan were performed to assess fracture lines and the presence of anteromedial tibial and/or talar spurs; which are the likely pathognomic lesion in the development of MMSFs. All patients underwent open reduction and internal fixation with 3 screws, and arthroscopic debridement of impringement spurs, and concentrated bone marrow aspirate into the fracture site. Patients completed the Ogilvie-Harris score, and all patients had CT scans at 3 months and until union.
Results: All the cohort patients had causative bony spurs that were debrided at surgery. All of the cohort achieved clinical union. All patients were able to return to professional football; at the same level as prior to the injury. There was complete cohort followup; 81% of patients were graded as excellent and 19% as good by the Ogilvie-Harris score. 50% of our cohort demonstrated varus malalignment, either genu varum or hindfoot varus.
Conclusions: The authors conclude that open reduction internal fixation of MMSFs with screws combined with arthroscopic spur debridement results in excellent outcomes. We conclude that varus lower limb malalignment is a risk factor for MMSFs. This study demonstrates that multimodal operative treatment produces excellent outcomes in high demand professional footballers. This study is the first to report a biomechanic association, which can alert the clinician to preventative measures; such as hindfoot orthoses.
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