Abstract:
PURPOSE : To provide return‐to‐performance outcomes after surgical
treatment for medial malleolus stress fractures in the elite athlete.
Additionally, to describe an individualised surgical approach in the
management of medial malleolus stress fractures.
METHODS : Five athletes (six ankles) underwent surgical treatment for a
medial malleolus stress fracture. The surgical technique was based on the
extent of the fracture line in steps with first arthroscopic debridement of bony
spurs, microfracturing of the fracture line and screw fixation. Return‐toperformance
data included time to return to sport‐specific training, normal
training, first competitive activity, performance and the return‐toperformance
rate.
RESULTS : Patients returned to sport‐specific training at a median of 10
weeks. They started normal training at 16 weeks postoperatively and
returned to their first competitive activity after 19 weeks. All patients had
bony spurs on the distal tibia which were arthroscopically debrided. One
patient received arthroscopic debridement of bony spurs alone. Four
patients received additional microfracturing of the fracture line and three
patients received screw fixation. All patients achieved clinical and
radiographic union on follow‐up computed tomography scan at 3 months
postsurgery. At latest follow‐up, no refractures nor hardware complications,
nor any other complications were observed.
CONCLUSION : Arthroscopic debridement of bony spurs, debridement and
microfracturing of the fracture line and screw fixation are all viable surgical
tools in the management of medial malleolus stress fractures in elite
athletes. The surgical approach containing these options should be tailored
to the individual athlete based on the fracture line in the sagittal plane. While most athletes return to full competitive activity in 3–4 months, time to selfreported
return to full performance is often much longer.
