How is return-to-play determined following treatment of a pars interarticularis injury?

Updated: Jan 22, 2019
  • Author: Gerard A Malanga, MD; Chief Editor: Craig C Young, MD  more...
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Answer

Return-to-play protocol depends on the individual's progress and the stage of the pars injury. Herring and Standaert recommended that the athlete progressively return to the sport if he/she is asymptomatic after 4-6 weeks with a mature corticated fracture on CT scan. [46] According to the investigators, if the CT scan shows an earlier stage lesion with either a stress reaction or minimal separation with noncorticated or cystic margins, the potential for true bone healing exists, and they recommend a more extensive rest protocol of 12 weeks, with no participation in sports and no extensive physical activity beyond that associated with normal daily activities. After a gradual rehabilitation program and no symptoms, the athlete can progressively return to the sport. [46]

Congeni et al recommended that after 8 weeks from the diagnosis, the athlete can return to play if he/she has been pain free during therapy, at rest, with hyperextension, and with the specific athletic activity. [49] Omey et al recommend that with early spondylolytic lesions, a rigid brace be applied for 6-9 months before returning to the sport. [81] The athlete must be pain free when playing the sport with the brace applied before discontinuing its use.

In general, there is no official time guideline for return to play in the literature; however, the general consensus for return to play is for the athlete to be asymptomatic at rest, with activity, with hyperextension, and when playing the specific sport.


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