title: The incidence and distribution of stress fractures in elite tennis players.
abstract: BACKGROUND
  Modern professional tennis involves powerful movements repeatedly subjecting the musculoskeletal system to heavy mechanical load. Thus tennis players are exposed to high risk of overuse injuries including stress fractures.
  
  
  OBJECTIVE
  To determine the incidence and distribution of stress fractures in elite tennis players.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  The cohort study population consisted of 139 elite players (mean (SD) age, 20.0 (5.0) years; 48 female, 91 male). Stress fractures were identified and confirmed radiologically from medical records during a two year period. Injuries were analysed according to age, sex, site, severity, delay in diagnosis, and time needed to return to sports.
  
  
  RESULTS
  15 players sustained 18 stress fractures, corresponding to an overall case incidence of 12.9% (95% confidence interval (CI), 8.1 to 20.0). The tarsal navicular was most affected (n = 5; 27%), followed by the pars interarticularis (n = 3; 16%), the metatarsals (n = 3; 16%), the tibia (n = 2; 11%) and the lunate (n = 2; 11%). Magnetic resonance imaging showed a greater incidence of "high grade" lesions (94.4%). Stress fracture incidence was significantly higher in juniors (20.3% (95% CI, 11.4 to 33.2)) than in professional players (7.5% (2.8 to 15.6)) (p = 0.045).
  
  
  CONCLUSIONS
  There was a high absolute risk (12.9%) of stress fractures in elite tennis players over a two year period. Junior players were at highest risk. The lesions are a major cause of disruption both of training and of competition. Risk factors should therefore be identified and prevention emphasised.
authors.affiliation: High Performance National Training Centre (CeNARD), Mayling CC, Ruta Panamericana Km 50 Pilar, Buenos Aires 1631, Argentina. jmaquirriain@yahoo.com
authors.forename: J
authors.initials: J
authors.lastname: Maquirriain
authors.forename: J P
authors.initials: JP
authors.lastname: Ghisi
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D015775:Fractures, Stress / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013715:Tennis / Q000293:injuries*