Expected Time to Return to Athletic Participation After Stress Fracture in Division I Collegiate Athletes

Abstract

Background: Few studies have documented expected time to return to athletic participation after stress fractures in elite athletes.

Hypothesis: Time to return to athletic participation after stress fractures would vary by site and severity of stress fracture.

Study design: Retrospective cohort study.

Level of evidence: Level 3.

Methods: All stress fractures diagnosed in a single Division I collegiate men's and women's track and field/cross-country team were recorded over a 3-year period. Site and severity of injury were graded based on Kaeding-Miller classification system for stress fractures. Time to return to full unrestricted athletic participation was recorded for each athlete and correlated with patient sex and site and severity grade of injury.

Results: Fifty-seven stress fractures were diagnosed in 38 athletes (mean age, 20.48 years; range, 18-23 years). Ten athletes sustained recurrent or multiple stress fractures. Thirty-seven injuries occurred in women and 20 in men. Thirty-three stress fractures occurred in the tibia, 10 occurred in the second through fourth metatarsals, 3 occurred in the fifth metatarsal, 6 in the tarsal bones (2 navicular), 2 in the femur, and 5 in the pelvis. There were 31 grade II stress fractures, 11 grade III stress fractures, and 2 grade V stress fractures (in the same patient). Mean time to return to unrestricted sport participation was 12.9 ± 5.2 weeks (range, 6-27 weeks). No significant differences in time to return were noted based on injury location or whether stress fracture was grade II or III.

Conclusion: The expected time to return to full unrestricted athletic participation after diagnosis of a stress fracture is 12 to 13 weeks for all injury sites.

Clinical relevance: Athletes with grade V (nonunion) stress fractures may require more time to return to sport.

Keywords: bone; runner; stress fracture; stress reaction; track and field.

Figure 1.

Oblique radiograph of a 21-year-old male long jumper with Kaeding-Miller grade III stress fracture of the fifth metatarsal proximal diaphysis.

Figure 2.

T2-weighted axial magnetic resonance image of a Kaeding-Miller grade II stress fracture of the fourth metatarsal in a 20-year-old female long-distance runner.

Figure 3.

Kaeding-Miller grade V stress fracture of the anterior tibial cortex in a 19-year-old female middle-distance runner who required intramedullary rodding to allow for complete healing.