Risk Factors for Reoperation and Performance-Based Outcomes After Operative Fixation of Foot Fractures in the Professional Athlete: A Cross-Sport Analysis

Abstract

Background:Professional athletes are predisposed to fractures of the foot due to large stresses placed on the lower extremity. These players are concerned with efficiently returning to play at a high level. Return-to-play rates after operative treatment have been previously reported, yet performance outcomes after such treatment are generally unknown in this population.Hypothesis:Overall, professional athletes sustaining a foot fracture would return to play at high rates with little impact on postoperative performance or league participation. However, National Football League (NFL) athletes would have a significantly greater decline in performance due to the high-impact nature of the sport.Study Design:Case series.Level of Evidence:Level 4.Methods:Athletes in the National Basketball League (NBA), NFL, Major League Baseball (MLB), and National Hockey League (NHL) undergoing operative fixation of a foot fracture were identified through a well-established protocol confirmed by multiple sources of the public record. Return-to-play rate and time to return were collected for each sport. League participation and game performance data were collected before and after surgery. Statistical analysis was performed, with significance accepted as P ≤ 0.05.Results:A total of 77 players undergoing 84 procedures met the inclusion criteria. Overall, 98.7% (76/77) of players were able to return to play, with a median time to return across all sports of 137 days. Players returned to preoperative performance levels within 1 season of surgery. Six players (7.8%) sustained refracture requiring reoperation, all of whom were in the NBA. Percentage of games started during the season after primary operative treatment was a predictive factor for reinjury (99% vs 40%, P = 0.001).Conclusion:Athletes returned to play at a high rate after foot fracture fixation, with excellent postoperative performance levels, regardless of sport and fracture location. NBA athletes sustaining fifth metatarsal and navicular fractures are at greater risk of reinjury compared with other athletes. Returning to high levels of athletic participation soon after surgery may predispose athletes to refracture and subsequent reoperation.Clinical Relevance:Players, coaches, and team physicians should be aware of the impact of foot fractures on career performance and longevity to best guide therapy.

Systematic Review of Orthopaedic and Sports Medicine Injuries and Treatment Outcomes in Women's National Basketball Association and National Basketball Association Players

“…Four studies were categorized into stress injuries and fractures of the foot/ankle. 5 , 26 , 42 , 49 Khan et al 26 evaluated bony stress injuries in the lower extremity between 2005 and 2015, and 76.1% of these occurred in the foot or ankle. Stress reactions had a 13% progression rate to fracture, and those with stress injuries had a significant decline in number of games played after injury (2 years before vs 2 years after, 72.0 ± 12.7 vs 61.3 ± 20.2, respectively; P = .014).…”

A Systematic Review of the Orthopaedic Literature Involving National Football League Players

“…22,69,76,116,140 There was a nonsignificant association with player availability in 1 study 22 and no association in another, 140 as well as a negative effect on performance. 131 Successful completion of at least 1 college season after surgery for fifth metatarsal fracture decreased the likelihood of reinjury. 117 Operative treatment was successful at maximizing RTP when it employed (1) a protocol of fixation with a Jones-specific intramedullary screw and iliac crest bone marrow aspirate with demineralized bone matrix injected at the fracture site, (2) noninvasive bone stimulators, (3) use of customized orthoses, and (4) an aggressive patient-specific rehabilitation protocol; however, 12% developed nonunion and required revision surgery when returning during the same season (at a mean of 9 weeks).…”

<p>A Systematic Review of the Orthopedic Literature Involving National Hockey League Players</p>

“…Citing a lack of outcomes in the literature regarding elite athletes undergoing operative management of foot fractures, Singh et al investigated RTP rates and postoperative performance in NBA, NFL, MLB, and NHL players. 47 Of the 84 operative procedures, 3 occurred in NHL players. NHL players had first metatarsal fractures and a navicular fracture.…”

“…NHL players were omitted from the performance analysis due to the small sample size, and the authors concluded that overall, athletes had excellent postoperative outcomes with a RTP of 98.7% regardless of sport and fracture location. 47…”