Common Benign Bone Lesions and Return to Sports: A Case Report and Scoping Review

Abstract

Background: Benign bone lesions are a common incidental finding in athletes during workup for musculoskeletal complaints, and athletes are frequently advised to halt participation in contact sports. There are no current guidelines to assist clinicians in referring patients with these lesions to a subspecialist or in advising athletes on the safety of returning to sport. Purpose: To assist sports medicine physicians in appropriate referral for patients with benign bone lesions through presentation of a literature review and the case of an adolescent athlete with a benign bone lesion in a location with a significant fracture risk. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature review was performed using the PubMed database. Search terms included “enchondroma,”“unicameral bone cyst,”“UBC,”“simple bone cyst,”“SBC,”“aneurysmal bone cysts, “ABC,”“nonossifying fibroma,”“NOF,”“non-ossifying fibroma,”“chondroblastoma,”“osteochondroma,”“exostosis,”“chondromyxoid fibroma,”“periosteal chondroma,” and “fibrous dysplasia” combined with “fracture,”“sports,”“sport,”“contact sport,”“football,” or “rugby.” Randomized controlled trials, case series, and prospective and retrospective studies were all included. Abstracts were excluded. Results: In total, 42 separate articles were reviewed. The strength of evidence for each lesion was determined using the total number of patients described in the literature with the pathology. Unicameral bone cysts, aneurysmal bone cysts, and fibrous dysplasia, particularly in the spine, are associated with a high risk of fracture; therefore, subspecialist referral is warranted before returning to sport. Osteochondromas (exostosis), juxtacortical chondromas, nonossifying fibromas, chondromyxoid fibromas, and enchondromas were associated with low fracture risk, and decisions regarding referral can be made on a case-by-case basis. Conclusion: The presence of a benign bone lesion does not always necessitate immediate, absolute restriction from participation in contact sports. After appropriate workup and diagnosis, the risk of return to sport should be evaluated based on the pathology present, and the patient and clinician should engage in a shared decision-making process. The guidelines in this paper provide context for stratifying risk and the importance of specialist referral. For athletes with a confirmed diagnosis of an asymptomatic benign bone lesion with a low risk of fracture, return to play without restrictions or referral is often safe.