Management of sports overuse injuries of the lower limb : an evidence-based review of the literature

Abstract

This article reviews common lower limb sports overuse injuries relevant to the orthopaedic surgeon. The following conditions are covered: • Snapping hip syndrome • Iliotibial band syndrome • Patellar tendinopathy • Achilles tendinopathy • Medial tibial stress syndrome • Tibial stress fractures • Chronic compartment syndrome These conditions can be managed conservatively in most cases. Adequate rest followed by a graded rehabilitation is extremely important. Intrinsic and extrinsic contributing factors must be sought for and corrected. It is only in the uncommon case of failed conservative treatment that surgical intervention is necessary. For each of the above conditions, the indications for surgery, surgical principles, various surgical procedures and results and complications thereof are analysed and discussed. A meta-analysis of surgical treatment studies with similar methodologies was performed. The majority of studies found were of Level IV evidence with small patient numbers. The recommended outcome measures to assess results of surgical intervention are relief of pain and return to pre-injury level of sporting activity. Surgical treatment often does not result in a cure but an improvement of symptoms. Prospective randomised control trials with adequate patient numbers comparing different surgical treatments are needed.