Summary

Our study shows that runners had decreased mileage after treatment as compared to before their injury, although most achieved the same or faster average mile times after treatment.

Abstract

Background

The purpose of our study was to assess the disease presentation, course, and outcomes among athletes diagnosed and treated for sacral stress fractures. Our specific aims were to (1) characterize presenting symptoms and treatment modalities used, (2) evaluate pre-injury, post-injury, and post-treatment sports performance, and (3) determine the incidence of known risk factors for stress fractures.

Methods

We conducted a retrospective review of medical records to identify patients who were diagnosed with sacral stress fractures at a single urban academic institution. Fractures were diagnosed on non-contrast T2-weighted magnetic resonance imaging (MRI) and categorized using the Bakker classification system. Subjects were administered an electronic survey that asked questions about (1) the onset, time course, and location of pain and other associated symptoms, (2) time to treatment and treatment modalities pursued, (3) sports performance and time to return to sport, and (4) known risk factors for stress fractures.

Results

13 of 18 eligible patients (72.2%) completed the survey with mean follow-up of 49.6 months (range 1-144). Mean age was 28.0 years (range 18-52). Nine patients (69.2%) were female of whom seven (77.8%) were premenopausal. Most patients presented with acute-onset lumbosacral back pain in the setting of running/jogging activities. All patients underwent non-operative treatment for an average of 3.8 months (range 0-8) and three-quarters reported pain resolution at last follow-up. Rate of return to sport was 83.3% but most patients reported ongoing deficits in running performance. Average time to return to sport was 5.9 months (range 2-12). Out of nine competitive runners, six were able to return to competitive running after completing treatment. The two patients that did not return to sport cited newly-diagnosed osteoporosis and chronic pain as their reasons, respectively. All 11 patients underwent conservative management regardless of their Bakker fracture classification (two type As, eight type Bs, and even one type C). 5 out of 8 (62.5%) of those with type B fractures returned to sport and the one patient with a type C fracture also returned.

Conclusion

Our study shows that runners had decreased mileage after treatment as compared to before their injury, although most achieved the same or faster average mile times after treatment. Our data suggested that based on return to sport scores and VAS scores for those with type B and type C Bakker classifications conservative management may be sufficient for successful outcomes. Other than case reports, to our knowledge, this is the first study to assess return to competitive sport after sacral stress fractures.