Major League Soccer players who suffer a fifth metatarsal fracture have a high rate of return to sport, according to a new study.
Soccer: 95% Return After Fifth Metatarsal Fracture
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“Sports-related fractures of the fifth metatarsal are common in professional athletes. Data regarding outcomes of surgical management including refracture, complications, and return-to-play statistics are available for other professional American sports with a notable exception of soccer,” the authors of “Outcomes of Surgically Treated Fifth Metatarsal Fractures in Major League Soccer Athletes,” wrote.
The study, which was published online in The American Journal of Sports Medicine on August 6, 2021, compared outcomes Major League Soccer players’ experience after surgery to fix fifth metatarsal fractures to those outcomes of other types of athletes. They particularly looked at refracture and complication rates and any factors that may adversely impact treatment success.
For their analysis, the researchers used data from the HealtheAthlete database for Major League Soccer for seasons 2013 to 2017. Information on demographics, treatment, postoperative course, and return-to-play statistics were also collected from HealtheAthlete and then supplemented by information from teams’ chief medical officers, coaches, trainers, and online sources.
Overall, there were 21 fractures in 18 players during these seasons. The mean time to radiographic healing was 8.5 weeks (n = 17). Twenty (95%) of the injured players returned to sport. The mean time to return to play was 11.1 weeks. Four players experienced refracture.
The researchers reported what while player’s performance characteristics showed small declines in the first year post surgery, they improved by the second year.
Several of the injured athletes had suffered previous stress injuries on the contralateral and ipsilateral limb.
“Major League Soccer athletes who sustain a sports-related fifth metatarsal fracture can expect a high rate of return to sport with time to radiographic healing and return to play as well as risk of refracture similar to other professional cohorts,” they wrote.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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