{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T01:23:36Z","timestamp":1781141016828,"version":"3.54.1"},"reference-count":19,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T00:00:00Z","timestamp":1717372800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To provide return\u2010to\u2010performance\u00a0outcomes 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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\u2010to\u2010performance data included\u00a0time to return to sport\u2010specific training, normal training, first competitive activity, performance\u00a0and the return\u2010to\u2010performance rate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients returned to sport\u2010specific training at a median of 10 weeks. They started normal training at 16 weeks postoperatively\u00a0and 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\u2010up computed tomography scan at 3 months postsurgery. At latest follow\u2010up, no refractures nor hardware complications, nor any other complications were observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Arthroscopic debridement of bony spurs, debridement and microfracturing of the fracture line\u00a0and 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\u20134 months, time to self\u2010reported return to full performance is often much longer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>Level IV.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ksa.12284","type":"journal-article","created":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T09:35:14Z","timestamp":1717407314000},"page":"3097-3104","source":"Crossref","is-referenced-by-count":3,"title":["Most elite athletes return to preinjury competitive activity after surgical treatment for medial malleolus stress fractures"],"prefix":"10.1002","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-4288-8510","authenticated-orcid":false,"given":"Kishan R.","family":"Ramsodit","sequence":"first","affiliation":[{"name":"Amsterdam UMC location University of Amsterdam Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9 Amsterdam The Netherlands"},{"name":"Academic Center for Evidence Based Sports Medicine (ACES) Amsterdam The Netherlands"},{"name":"Amsterdam Collaboration on Health and Safety in Sports (ACHSS), IOC Research Center of Excellence Amsterdam The Netherlands"},{"name":"Amsterdam Movement Sciences (AMS), Aging &amp; Vitality, Musculoskeletal Health, Sports Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben","family":"Zwiers","sequence":"additional","affiliation":[{"name":"Amsterdam UMC location University of Amsterdam Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9 Amsterdam The Netherlands"},{"name":"Academic Center for Evidence Based Sports Medicine (ACES) Amsterdam The Netherlands"},{"name":"Amsterdam Collaboration on Health and Safety in Sports (ACHSS), IOC Research Center of Excellence Amsterdam The Netherlands"},{"name":"Amsterdam Movement Sciences (AMS), Aging &amp; Vitality, Musculoskeletal Health, Sports Amsterdam The Netherlands"},{"name":"Department of Orthopedic Surgery Flevoziekenhuis Almere The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6043-698X","authenticated-orcid":false,"given":"Miki","family":"Dalmau\u2010Pastor","sequence":"additional","affiliation":[{"name":"Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences The University of Barcelona Barcelona Spain"},{"name":"MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society) Merignac France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0126-4177","authenticated-orcid":false,"given":"Vincent","family":"Gouttebarge","sequence":"additional","affiliation":[{"name":"Amsterdam UMC location University of Amsterdam Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9 Amsterdam The Netherlands"},{"name":"Academic Center for Evidence Based Sports Medicine (ACES) Amsterdam The Netherlands"},{"name":"Amsterdam Collaboration on Health and Safety in Sports (ACHSS), IOC Research Center of Excellence Amsterdam The Netherlands"},{"name":"Amsterdam Movement Sciences (AMS), Aging &amp; Vitality, Musculoskeletal Health, Sports Amsterdam The Netherlands"},{"name":"Section Sports Medicine, Faculty of Health Sciences University of Pretoria Pretoria South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gino M. 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