Fractures

After reviewing the current literature, counseling athletes to undergo early reconstruction after ACL injury may not be in the athlete’s best interest. Undergoing reconstruction does not guarantee athletes return to their preinjury sport, and return to the preinjury competitive level of sport is unlikely. The risk of a second injury is high in young athletes returning to sport, especially in the short term. The risk for developing osteoarthritis is high in the long term regardless of surgical intervention, and even higher if a revision procedure is required.

 A Cochrane Review found that there was insufficient evidence to recommend ACLR compared with nonoperative treatment, and recent randomized, controlled trials have found no difference between those who had ACLR and those treated nonoperatively with regard to knee function, health status, and return to preinjury activity level and sport after 2 and 5 years in young, active individuals. With no differences in outcomes between early reconstruction, delayed reconstruction, and no surgery at all, counseling should start by considering nonoperative management. Researchers have found a 5-week progressive exercise program after ACL injury led to significantly improved knee function before deciding to undergo reconstruction or remain nonoperatively managed

Essential Literature

DIAGNOSIS, TREATMENT, AND REHABILITATION OF STRESS FRACTURES IN THE LOWER EXTREMITY IN RUNNERS
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Conclusion:
Diagnosis, rehabilitation, and return to running activities require similar assessment and progression for most lower extremity stress fractures. Specific special tests and differential diagnosis may vary, depending on the anatomical site of the stress fracture; regardless, prompt diagnosis is imperative in order to begin appropriate treatment plans. The most difficult aspect of stress fracture treatment entails mitigating internal and external risk factors. Practitioners should address ongoing risk factors to minimize reccurrence.

Diagnosis, treatment, and rehabilitation of stress fractures in the lower extremity in runners
Kahnov et. al 2015
Conclusion:
Diagnosis, rehabilitation, and return to running activities require similar assessment and progression for most lower extremity stress fractures. Specific special tests and differential diagnosis may vary, depending on the anatomical site of the stress fracture; regardless, prompt diagnosis is imperative in order to begin appropriate treatment plans. The most difficult aspect of stress fracture treatment entails mitigating internal and external risk factors. Practitioners should address ongoing risk factors to minimize reccurrence.