Background: Fractures of the proximal fifth metatarsal metaphysis (ie, the Jones fracture) can be problematic in the elite athlete because of a high incidence of nonunion and refracture with nonoperative treatment. Although these fractures are not common, athletes can suffer refracture or nonunion of a Jones fracture despite operative stabilization. This is often attributable to hardware of insufficient strength, aggressive postoperative rehabilitation, or biologic insufficiency at the fracture site.
Purpose: The authors review the results of revision intramedullary screw fixation with cancellous autologous bone grafting or bone-marrow aspirate combined with demineralized bone matrix after refracture or nonunion of Jones fractures in elite athletes.
Study Design: Case series; Level of evidence, 4.
Methods: The authors retrospectively reviewed the clinical and radiographic outcomes and return to sport in 21 elite athletes undergoing treatment of Jones fracture refractures or nonunions. All patients underwent intramedullary screw fixation with autologous bone graft (12 patients), bone-marrow aspirate (BMA) + demineralized bone matrix (DBM) (8 patients), or no bone graft (1 patient).
Results: All athletes were able to return to their previous level of athletic competition at an average of 12.3 weeks. All fractures showed clinical and radiographic evidence of compete cortical healing. Only 1 patient subsequently suffered a refracture.
Conclusion: The authors recommend revision fixation with a large, solid screw (5.5 mm or larger) and autologous bone grafting for symptomatic refractures and nonunions of the proximal fifth metatarsal in elite athletes. Additional investigation is needed to determine whether BMA combined with DBM is an effective substitute for cancellous autograft.
Background: The most common ankle injury is the lateral ankle sprain. Dutch annual sports-related ankle sprain costs can roughly be estimated at 187,200,000. Research has shown that proprioceptive training accounts for an approximated overall 50% reduction in ankle sprain recurrence rate.
Hypothesis: An unsupervised proprioceptive training program to reduce the recurrence of lateral ankle sprains will reduce overall health care costs.
Design: Cohort study (economic analysis); Level of evidence, 2.
Methods: The study included 522 male and female athletes: 256 athletes (120 female and 136 male) in the intervention group, and 266 athletes (128 female and 138 male) in the control group. Both groups received treatment according to usual care. Athletes allocated to the intervention group received an 8-week proprioceptive training program in addition to usual care. Costs per athlete and costs per injured athlete were calculated. Costs related to ankle sprain recurrences were measured from a societal perspective using cost diaries. Bootstrapping was used to analyze the cost-effectiveness data. Follow-up was 1 year.
Results: Mean total costs in the intervention group were 81 (standard deviation, 134) per athlete and 114 (325) per injured athlete. Mean overall costs in the control group were 149 (836) per athlete and 447 (1403) per injured athlete. Statistically significant differences in total costs were found per athlete (mean difference, –69; 95% confidence interval, –200 to –2) and per injured athlete (–332; –741 to –62) in favor of the intervention group. A cost-effectiveness plane showed the effect of the intervention was larger and the costs were lower in the intervention group than the control group.
Conclusion: The use of a proprioceptive training program after usual care of an ankle sprain is cost-effective for the prevention of ankle sprain recurrences in comparison with usual care alone. In the Netherlands, an estimated annual 35.9 million in medical and lost productivity costs can be saved solely by advocating a proprioceptive training program as in the present study.
Background
Modification of the Bröstrom repair with suture anchors has been used to address chronic lateral ankle instability. However, there are few studies in the literature reporting the functional outcomes after this particular procedure in the high-demand athlete.
Hypothesis
Anatomical reconstruction of the lateral ankle ligaments for chronic instability will return the high-demand athlete functionally to his or her previous level of activity.
Study Design
Case series; Level of evidence, 4.
Methods
Sixty-two patients who had grade III ankle sprain that failed at least a 6-month course of supervised conservative management with a preinjury Tegner score of ≥ 6 underwent a variant of the Gould-modified Broström procedure with suture anchors for lateral ankle instability. Each patient was given the Tegner and Karlsson questionnaire at the 6-month, 1-year, and 2-year time points. Range of motion of the operative ankle was also assessed. The mean age was 19.6 years (range, 16–26 years), and 10 patients were lost to follow-up.
Results
The mean follow-up was 29 months (minimum, 24 months) in the remaining 52 patients (84%). Mean Tegner scores at the 1- and 2-year time points were 8.2 (range, 5–9) and 8.6 (range, 5–9), respectively. The mean Karlsson scores were 92 ± 5.2 and 95 ± 3.1 at the 1- and 2-year time points, respectively. Range of motion was equal to the contralateral ankle in all but 3 patients at the 2-year follow up. A 6% major complication rate included 3 reruptures.
Conclusion
Anatomical ligament reconstruction for chronic lateral ankle instability using a variant of the Gould-modified Broström procedure with suture anchors was effective in returning high-demand athletes to their preinjury functional level.
