Football Traumatology (eBook)

Dr. Piero Volpi is an Orthopedic Surgeon and Sports Medicine Specialist and Director of the Knee Surgery and Sport Traumatology Unit at Humanitas Clinical Institute IRCCS, Milan. He played professional football from the beginning of the 1970s until 1985 while maintaining his medical studies. He is now Head of Medical Staff FC Internazionale Milan, Italy, and is also Responsible Physician of the Italian Association of Football Players (AIC).  Dr. Volpi  is Teaching Professor at the Speciality School  of Orthopedics and Traumatology at the University of Milan.  He is also Vice-President of  Italian Arthroscopy Society (SIA) and member of  several National and International Scientific Societies: Siot, Sigascot,Fmsi, Isakos, Esska, Eka. He is the author of more than 300 publications and over 600 contributions, including book chapters, articles and presentations to scientific National and International meetings .He is Editor in Chief of the Journal of Sports Traumatology and member of Editorial Board of  Medicina dello Sport Journal.

Foreword I 6
Foreword II 8
Preface 10
About the Editor 12
Contents 14
Part I: General Concepts 17
1: Epidemiology in Professional Footballers 18
1.1 Methodology 18
1.2 Main Challenges 19
1.3 Epidemiological Researches in Professional Football 19
1.4 Injury Incidence 19
1.5 Match and Training Injury Rates 20
1.6 Reinjuries 20
1.7 Types and Locations of Injury 20
1.8 Overuse and Traumatic Injuries 21
1.9 Injury Trends 21
1.10 Women Football 22
1.11 Youth Football 22
1.12 Influence of the Medical Staff on Injuries 22
References 22
2: Epidemiology in Young Football Players 25
2.1 Introduction 25
2.2 Injury Incidence and Prevalence 25
2.3 Injury Characteristics 26
2.3.1 Mechanisms of Injury 26
2.3.2 Location of Injury 26
2.3.3 Type of Injury 28
2.3.4 Severity of Injury and Return to Play 28
2.4 Injury Types of Particular Relevance in Youth Football 29
2.4.1 Strains and Sprains 29
2.4.2 Fractures 29
2.4.3 Overuse Complaints Related to Growth and Maturation 29
2.4.4 Head Injuries and Concussions 30
2.5 Conclusions and Potential for Injury Prevention 30
References 31
3: Epidemiology in Female Football Players 34
3.1 Introduction 34
3.2 Injury Rate 35
3.3 Type and Location of Injury 36
3.4 Long-Term Health Consequences 36
Conclusion 38
References 38
4: Risk Factors 41
4.1 Risk Factors 41
4.2 Intrinsic Risk Factors 41
4.3 Extrinsic Risk Factors 42
References 44
5: Football Injury Prevention 46
5.1 Introduction 46
5.2 Why Is Injury Prevention Important? 46
5.3 Injury Prevention Research 47
5.4 Prevention of Injuries: Scientific Evidence 47
5.5 Development and Research Around FIFA 11+ 49
5.6 Dissemination/Implementation of FIFA 11+ 51
5.7 Challenges I: Injury Prevention to the Pitch 51
5.8 Challenges II: At Professional Level 53
5.9 Special Group: Referees 55
Conclusions 55
References 55
6: Preseason Evaluation 58
Conclusion 60
7: Trauma Management in the Field 61
7.1 Introduction 61
7.1.1 Emergency Personnel 61
7.1.2 Emergency Communication 62
7.1.3 Emergency Equipment 62
7.1.3.1 Medical Emergency Transportation 62
7.2 On-the-Field Injury Assessment 63
7.2.1 Primary Survey 63
7.2.2 Secondary Survey 65
7.3 Controlling Bleeding 65
7.4 Emergency Splinting 66
7.4.1 Splinting Principles 67
7.4.2 Type of Splinting 67
7.4.3 Injury-Specific Splints 67
7.5 Immediate Treatment Following Acute Musculoskeletal Injury 69
7.6 Moving and Transporting the Injured Athlete 70
7.6.1 Suspected Spinal Injury 70
7.6.2 Stretcher Carrying 71
7.6.3 Ambulatory Aid 71
7.6.4 Manual Conveyance 72
7.7 Conclusions: Key Points 72
References 72
Part II: Specific Injuries 73
8: Muscle Lesions 74
8.1 Aetiology 74
8.1.1 Contusions 74
8.1.2 Muscle Tears 74
8.1.2.1 Lacerations 76
8.1.2.2 Ischaemia 76
8.1.2.3 Drug Toxicity 76
8.2 Injury Mechanism 76
8.2.1 Contusions 76
8.2.2 Muscle Tears 77
8.3 Clinical and Diagnostic Examination 77
8.4 Treatment Strategy 79
8.4.1 Rehabilitation and Return to Play 81
8.4.2 Return to Play 82
References 82
9: Hamstring Injuries 85
9.1 Hamstring Strain Injuries 85
9.2 Mechanisms of Causes of Injury 86
9.3 Diagnosis 87
9.4 Prognosis 88
9.5 Risk Factors 88
9.6 Prevention 92
9.7 Basic Principles of Treatment 93
9.8 Acute Phase 93
9.9 Remodeling Phase 94
9.10 Functional Recovery Phase 94
References 96
10: Patellar and Quadriceps Tendinopathy 100
10.1 Introduction 100
10.2 Epidemiology and Predisposing Factors 100
10.3 Symptomatology and Classification 101
10.4 Radiological Findings 102
10.5 Anatomo-pathology 102
10.6 Treatment 102
10.7 Patellar Tendon Rupture 103
References 104
11: Return to Play After a Muscle Lesion 106
11.1 Introduction 106
11.2 Indirect Lesion of the Hamstring 107
11.3 Hamstring Lesion and Risk of Recurrence 107
11.4 Clinical Examination 108
11.5 Imaging Examination 108
11.6 Dynamometric Evaluation 108
11.7 Field Tests 110
11.8 General Parameters 111
11.9 Aerobic Aspects 113
Conclusions 114
References 114
12: Shoulder Injuries in Goalkeepers 116
12.1 Aetiology 116
12.2 Injury Mechanism 117
12.3 Clinical and Diagnostic Examination 118
12.4 Treatment Strategy 119
12.4.1 Tricks and Tips 122
12.4.2 Pectoralis Major Tear 122
12.5 Rehabilitation and Return to Play 122
12.5.1 Rotator Cuff Repair 122
12.5.2 Anterior Capsulolabral Procedure 123
12.5.3 Pectoralis Major Repair 123
References 123
13: Acromioclavicular Dislocation 125
13.1 Epidemiology and Incidence 125
13.2 Etiopathogenesis 125
13.3 Pathoanatomical Classification 126
13.4 Clinical Examination 126
13.5 Diagnosis 128
13.5.1 Radiography 128
13.5.2 Computed Tomography (CT) 128
13.5.3 Magnetic Resonance (MR) Imaging and MR Arthrography 129
13.6 Treatment 129
References 132
14: Knee Medial Collateral Ligament Injuries 133
14.1 Etiology/Epidemiology/Anatomy and Biomechanics 133
14.2 Injury Mechanism 134
14.3 Clinical and Diagnostic Examination 135
14.4 Treatment Strategy 135
14.4.1 Acute Injury Grade 3 MCL Injury 136
14.4.1.1 Technique 136
14.4.2 Surgical Treatment Chronic Injury 136
14.4.2.1 Complications 136
14.5 Rehabilitation and Return to Play 137
14.5.1 Mild MCL Injury 137
14.5.2 Moderate-to-Severe MCL Injury 137
14.6 Complications of Nonoperative Treatment 138
14.6.1 Postoperative Care 138
References 138
15: Injuries of the Lateral Collateral Ligament and Posterolateral Corner of the Knee 141
15.1 Introduction 141
15.2 Anatomy 141
15.3 Biomechanics 143
15.4 Clinical Diagnosis 143
15.5 Imaging 144
15.6 Treatment Strategy 145
15.6.1 Nonoperative Treatment 145
15.6.2 Operative Treatment 145
15.6.2.1 Surgical Approach 146
15.6.2.2 Primary Repair 146
15.6.2.3 Augmentation 146
15.6.2.4 Proximal Tibial Osteotomy 147
15.6.3 Postoperative Rehabilitation 148
References 148
16: Anterior Cruciate Ligament (ACL) Lesions 151
16.1 Epidemiology 151
16.1.1 Age 151
16.1.2 Match Play 151
16.1.3 Gender 152
16.1.4 Level 152
16.1.5 Ground 152
16.2 Injury Mechanism 153
16.3 Clinical and Diagnostic Examination 154
16.3.1 Lachman Test 154
16.3.2 Pivot Shift 154
16.3.3 Magnetic Resonance Imaging (MRI) 154
16.4 Treatment Strategy 154
16.4.1 Indications 154
16.4.2 Timing 155
16.4.3 Graft 155
16.4.4 Surgical Procedure 155
16.4.5 Rehabilitation After ACL Reconstruction 156
16.4.5.1 Active and Passive Motion 157
16.4.5.2 Full Weight Bearing 157
16.4.5.3 Brace 157
16.4.5.4 Functional Exercises 157
16.4.6 Return to Play 157
References 159
17: Anterior Cruciate Ligament Lesions in Adolescent 162
17.1 Introduction 162
17.2 Risk Factors 162
17.3 ACL Tear 163
17.4 Management of ACL Tear 163
17.4.1 Physeal Sparing Technique (Both Tibia and Femur) 164
17.4.2 Transphyseal and “All-Inside” Technique 164
17.5 Discussion 166
Conclusions 167
References 167
18: ACL Revision 169
18.1 Introduction and Epidemiology 169
18.2 Etiology of ACL Graft Failure and Revision Surgery 170
18.2.1 ACL Graft Failure 170
18.2.1.1 Technical Errors 170
Poor Tunnel Position 170
Graft Impingement 171
Failure of Fixation 171
Inappropriate Graft Tensioning 171
18.2.1.2 Diagnostic Errors (Associated Laxities/Malalignment) 171
18.2.1.3 Failure of Biological Graft Incorporation 172
18.3 Clinical and Diagnostic Examination 172
18.3.1 Clinical History and Examination 172
18.3.2 Medical Imaging 172
18.4 Treatment Strategy 174
18.4.1 Graft Choice 175
18.4.2 Management of Bone Tunnels and Fixation 175
18.4.2.1 Tunnels that Are Well Positioned 176
18.4.2.2 Tunnels That Are Poorly Positioned 176
18.4.2.3 Tunnels That Are in Intermediate Position 176
18.4.2.4 Two-Stage Revision ACL Reconstruction 176
18.4.3 Other Important Surgical Considerations 178
18.5 Results of Revision ACL Reconstruction 178
18.5.1 Literature Results 178
18.5.2 Rehabilitation and Return to Play 179
Conclusion 179
References 180
19: PCL Lesion 183
19.1 Introduction 183
19.2 Anatomy 183
19.3 Biomechanics 184
19.4 Epidemiology and Mechanisms of Sports-­related PCL Injury 184
19.5 Clinical Examination 185
19.5.1 Posterior Sag Test 185
19.5.2 Posterior Drawer Test 186
19.5.3 The Quadriceps Active Test 186
19.5.4 Other Tests 186
19.6 Imaging 187
19.7 Natural History of PCL Rupture and Conservative Treatment 187
19.8 Surgical Treatment 187
19.8.1 The Single Bundle Transtibial Technique 191
19.8.2 The Inlay Technique [26] 191
19.8.3 The Double Bundle Reconstruction 191
19.8.4 Complications 191
19.8.5 Rehabilitation 191
19.8.6 Clinical Outcomes After Surgical Reconstruction [20, 30] 192
Conclusion 192
References 192
20: Knee: Multiligament Injuries 195
20.1 Etiology 195
20.2 Injury Mechanism 195
20.2.1 Central Pivot and Posterolateral Corner (PLC) 195
20.2.2 MCL and Posteromedial Corner (PMC) 196
20.3 Clinical and Diagnostic Examination 196
20.3.1 Clinical Evaluation: Medial Compartment 196
20.3.2 Clinical Evaluation: Lateral Compartment 197
20.3.3 X-Ray 197
20.3.4 MRI 198
20.4 Treatment Strategy 198
20.4.1 Central Pivot and Medial Side 198
20.4.1.1 Surgical Technique 199
20.4.2 Central Pivot and Lateral Side 199
20.4.2.1 Surgical Technique 200
20.5 Rehabilitation and Return to Play 201
20.5.1 Rehabilitation 201
20.5.1.1 Phase I 201
20.5.1.2 Phase II 201
20.5.1.3 Phase III 201
20.5.1.4 Phase IV 201
20.5.2 Return to Play 202
References 202
21: Lateral Meniscus Injuries 204
21.1 Introduction 204
21.2 Etiology and Injury Mechanism 204
21.2.1 Stable Knee 204
21.2.2 Unstable Knee 205
21.3 Clinical Diagnosis and Imaging 205
21.3.1 Stable Knee 205
21.3.2 Unstable Knee 205
21.4 Treatment Strategy and Results 205
21.4.1 Partial Lateral Meniscal Replacement 206
21.4.2 Total Lateral Meniscal Replacement 207
21.5 Rehabilitation and Return to Play 208
21.5.1 Particular Findings 209
21.5.1.1 Meniscal Cysts in Adults and Football 209
Introduction 209
Etiology 209
Diagnostic Approach 209
Arthroscopic and Associated Open Treatment 209
Results 210
Conclusion 210
21.5.1.2 The Discoid Lateral Meniscus and Football 210
Diagnosis and Clinical Findings 210
Treatment 211
Conclusion 211
References 211
22: Medial Meniscus Injuries 215
22.1 Introduction 215
22.2 Etiology and Classification 215
22.3 Injury Mechanism 217
22.3.1 Longitudinal Tears 217
22.3.2 Transverse, Radial, or Oblique Tears 217
22.4 Clinical and Diagnostic Examination 218
22.4.1 Clinical Examination 218
22.4.1.1 Tests Commonly Used to Assess Meniscal Lesions 218
McMurray Test [14] 218
Apley Test [15] 218
Joint Line Palpation 218
Bragard Test 219
Steinman Second Test 219
22.4.2 Diagnostic Examination 219
22.4.3 Arthroscopy 220
22.5 Treatment Strategy 220
22.5.1 Conservative Treatment: Masterly Neglect 220
22.5.2 Surgical Treatment 221
22.5.2.1 (Sub)Total or Partial Meniscectomy 221
22.6 Suitability and Indications for Repair 221
22.7 Meniscal Grafts and Substitutes 222
22.8 Debridement 222
22.9 Technique 223
22.9.1 First Generation: Open Technique 223
22.9.2 Fixation 223
22.9.3 Second Generation: Arthroscopically Assisted Inside–Out or Outside–In Technique 223
22.9.3.1 Inside–Out Meniscus Repair 223
22.9.3.2 Outside–In Meniscus Repair 224
22.9.4 Third Generation: Devices 224
22.9.5 Fourth Generation: All-Inside Technique with Sutures 225
22.10 Rehabilitation and Return to Play 225
22.10.1 Rehabilitation After Meniscectomy 225
22.10.1.1 Rehabilitation Protocol 225
22.10.1.2 Early Postoperative Rehabilitation Phase 225
22.10.1.3 Second Phase 227
22.10.1.4 Third Phase 228
22.10.2 Rehabilitation After Meniscus Repair 228
22.10.2.1 Healing of the Meniscus 228
Healing Rate After Meniscus Repair 228
Extrinsic Factors Influencing Meniscus Healing After Meniscus Repair 228
Immobilization 228
Weight-bearing 229
Intrinsic Factors Influencing Meniscus Healing After Meniscus Repair 229
22.10.3 Protocol 229
22.10.3.1 Conventional Rehabilitation Protocol 229
22.10.3.2 Accelerated Rehabilitation Protocol 229
22.10.3.3 Individualized Rehabilitation Protocol 230
Conclusion 230
References 230
23: Anterior Knee Pain in Football 233
23.1 Introduction 233
23.2 Etiology 233
23.3 History and Clinical Examination 235
23.4 Imaging 237
23.5 Treatment Strategy 239
23.6 Return to Play 240
References 240
24: Patellar Instability in Football Players 242
24.1 Injury Mechanism 242
24.2 Epidemiology/Etiology 242
24.2.1 Influence of Exercise 243
24.2.2 Influence of Age 243
24.2.3 Influence of Sex 244
24.2.4 Influence of Ethnicity and Family History 244
24.2.5 Influence of Prior Subluxation/Dislocation 244
24.2.6 Influence of Osseous Factors 244
24.2.7 Influence of Soft Tissue Factors 246
24.2.8 Classification 246
24.3 Clinical and Diagnostic Examination 247
24.4 Treatment Strategy 248
24.5 Rehabilitation and Return to Play 250
24.5.1 Rehabilitation 250
24.5.2 Return to Play 250
References 251
25: Knee Cartilage Repair 254
25.1 Introduction 254
25.1.1 Aetiology-Epidemiology 254
25.1.2 Injury Mechanism 254
25.1.3 The Risks of Delayed Treatment and Special Considerations 255
25.2 Clinical and Diagnostic Examination 255
25.3 Treatment Strategy 256
25.3.1 Active Teenage Football Players 256
25.3.2 Active Adult Football Players 257
25.3.3 Retired or to Be Retired Football Players 258
25.4 Rehabilitation and Return to Play 259
25.4.1 Rehabilitation Protocol 259
25.5 Prediction of Outcomes 260
25.6 Conclusion/Suggestions 261
References 265
26: Patellar Tendon Lesions 267
26.1 Introduction 267
26.2 Epidemiology and Risk Factors 267
26.3 Biomechanics of the Extensor Apparatus 268
26.4 Pathogenesis 269
26.5 Clinical Symptoms 269
26.6 Instrumental Diagnosis 270
26.7 Treatment 270
References 272
27: PRP in Football Players 274
27.1 Introduction 274
27.2 Plasma Rich in Growth Factors (PRGF-Endoret®) Preparation 275
27.3 Knee Injuries 275
27.4 Hip Injuries 278
27.5 Ankle Injuries 279
27.6 Osteochondritis 280
27.7 Muscles Injuries 281
Conclusions 284
References 285
28: Knee Arthritis in Ex-Footballers 291
28.1 Etiology 291
28.2 Injury Mechanism 291
28.2.1 Malalignment 291
28.2.2 Loss of Meniscal Tissue 292
28.2.3 Meniscectomy 292
28.2.4 Meniscal Transplantation 293
28.2.5 Cartilage Defects 293
28.2.6 Joint Instability or Laxity 293
28.3 Diagnosis 294
28.4 Treatment Strategy 294
28.5 Surgical Treatment 295
28.6 Conclusion 297
28.6.1 Practical Implications 298
References 298
29: Groin Pain 300
29.1 Introduction 300
29.2 Groin Anatomy 300
29.3 Insertional Adductors and Rectus Abdominis Tendinopathy 302
29.3.1 Clinical Examination and Diagnosis 302
29.3.2 Treatment 303
29.4 Femoroacetabular Impingement Syndrome 303
29.4.1 Diagnosis 304
29.4.2 Treatment 305
29.5 Osteitis Pubis 306
29.5.1 Clinical Presentation and Diagnosis 306
29.5.2 Treatment 306
29.6 Sportsman Hernia/Athletic Pubalgia 307
29.6.1 Clinical Presentation and Diagnosis 308
29.6.2 Management 308
29.7 Greater Trochanter Pain Syndrome 308
29.7.1 Clinical Presentation and Diagnosis 308
29.7.2 Management 309
29.8 Summary 309
References 310
30: Femoroacetabular Impingement (FAI) in Football Traumatology 313
30.1 FAI 313
30.1.1 Clinical Presentation 313
30.1.2 Instrumental Exams 314
30.2 Isolated Acetabular Labrum Tear 315
30.2.1 Surgical Technique 315
30.2.2 Technical Notes 316
30.2.2.2 Rehabilitation 317
30.2.3 Outcome and Return to Play 317
30.3 Rectus Femoris Tendon Calcification 318
30.3.1 Surgical Technique 319
30.3.2 Rehabilitation 319
References 319
31: Achilles Tendon Lesions in Soccer Players 321
31.1 Introduction 321
31.2 Epidemiology 321
31.3 Etiology 321
31.4 Injury Mechanism 322
31.5 Clinical and Diagnostic Examination 322
31.6 Tendon Healing 323
31.7 Treatment Strategy 324
31.8 Rehabilitation and Return to Play 325
References 327
32: Ankle Ligament Lesions 329
32.1 Etiology 329
32.1.1 Lateral Ankle Ligaments 329
32.1.2 Tibiofibular Syndesmosis 329
32.2 Injury Mechanism 329
32.2.1 Lateral Ankle Ligaments 329
32.2.2 Tibiofibular Syndesmosis 330
32.3 Clinical and Diagnostic Examination 330
32.3.1 Acute Lateral Ligament Injury 330
32.3.2 Chronic Lateral Ankle Instability 331
32.3.3 Acute Syndesmotic Ligament Injury 331
32.3.4 Subacute and Chronic Syndesmotic Injury 333
32.4 Treatment Strategy 333
32.4.1 Acute Lateral Ligament Injury 333
32.4.2 Chronic Lateral Ankle Instability 334
32.4.3 Acute Syndesmotic Ligament Injury 334
32.4.4 Subacute and Chronic Syndesmotic Injury 335
32.5 Rehabilitation and Return to Play 335
32.5.1 Lateral Ligament Injury 335
32.5.2 Syndesmotic Ligament Injury 335
32.5.3 Sport-Specific Rehabilitation 336
32.5.4 Return to the Field 336
References 336
33: Ankle Osteochondral Lesions 339
33.1 Definition 339
33.1.1 Etiology 339
33.1.2 Injury Mechanism and Natural History 339
33.2 Clinical and Diagnostic Examination 340
33.3 Treatment Strategy 341
33.3.1 Acute Lesions 341
33.3.2 Chronic Lesions 342
33.3.2.1 Conservative Treatment 342
33.3.2.2 Retrograde Drilling 342
33.3.2.3 Microfractures 342
33.3.2.4 Mosaicplasty 342
33.3.2.5 Autologous Chondrocytes Implantation 343
33.3.2.6 Bone Marrow-Derived Cell Transplantation 343
33.3.2.7 Allograft 344
33.4 Rehabilitation and Return to Play 344
33.4.1 Fragment Fixation 344
33.4.2 Drilling 344
33.4.3 Microfractures 344
33.4.4 Mosaicplasty 344
33.4.5 ACI and BMDCT 344
Conclusions 345
References 345
34: Ankle Osteoarthritis in Ex-Professional Footballers 347
34.1 Ankle OA Occurrence in Ex-Professional Footballers 347
34.2 Etiology 348
34.3 Diagnostic: Clinical and Radiographic Examination 349
34.3.1 Clinical Examination 349
34.3.2 Radiographic Examination 350
34.4 Functional Consequences of Ankle OA in Ex-Professional Footballers 350
34.5 Treatment and Management Strategies 352
34.5.1 Conservative Strategies 352
34.5.2 Surgical Treatment 352
34.5.3 Self-Management Strategy 353
References 353
35: Foot Problems in Football 355
35.1 Introduction 355
35.2 The Football Shoe 355
35.3 The Inlay Soles 356
35.4 The Studs 356
35.5 The Footballer’s Foot and Static Problems 357
35.6 Dermatological and Cutaneous Lesions 357
35.7 Common Traumatic Foot Injuries in Football 358
35.7.1 Turf Toe (First Ray Metatarsophalangeal Sprain) 358
35.7.2 Metatarsal Fractures/Tarsometatarsal Dislocations 359
35.7.3 Midfoot Sprains (Lisfranc Injuries) 361
35.8 Common Nontraumatic Foot Injuries in Football 361
35.8.1 Stress Fractures 361
35.8.2 Hallux Rigidus 362
35.8.3 Plantar Fasciitis 363
35.9 Sesamoid Dysfunction 364
35.10 Rehabilitation of the Injured Footballer’s Foot 365
References 365
36: Stress Fractures of the Foot in Footballers 367
36.1 Etiology 367
36.2 Risk Factors 367
36.3 Localization of Stress Fractures of the Foot in Football Players 368
36.3.1 Fifth Metatarsal Bone Stress Fracture 368
36.3.1.1 Acute Fracture Treatment (Torg I) and Delayed Union (Torg II) 369
Nonoperative Treatment 369
Surgical Treatment 370
36.3.1.2 Chronic Fractures (Torg III) 370
Nonoperative Management 370
36.3.1.3 Surgical Treatment 370
Intramedullary Screw Fixation 370
Tension Band Wiring 371
Other Treatment Options 371
36.3.2 Navicular Stress Fractures 371
36.3.2.1 Pathophysiology 371
36.3.2.2 Clinical Presentation and Diagnosis 371
36.3.2.3 Differential Diagnosis 372
36.3.2.4 Treatment 372
36.3.3 Sesamoid Stress Fractures 373
36.3.3.1 Pathophysiology 373
36.3.3.2 Clinical Presentation 373
36.3.3.3 Diagnosis 373
36.3.3.4 Treatment 373
36.4 Other Different and Relatively Unusual Stress Fractures 374
36.4.1 The Base of the Fourth Metatarsal Bone 374
36.4.2 Talus Stress Fracture 374
36.4.3 Tibial Malleolar Stress Fractures 374
36.4.4 Calcaneal Stress Fractures 375
36.4.5 Base Metatarsal II Stress Fracture 375
36.5 In Summary 376
References 376
37: New Trends in Rehabilitation 380
37.1 Introduction 380
37.2 Scientific Background (From “Protection-Oriented” Rehabilitation to Functional Recovery) 380
37.3 Crucial Principles 381
37.4 Rehabilitation Strategy 382
37.5 Criteria-Based Rehabilitation 383
37.6 Return to Sport Philosophy 383
Conclusions 386
References 387
Erratum 388