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Surgical excision of symptomatic mature posttraumatic myositis ossificans: characteristics and outcomes in 32 athletes

  • Sports Traumatology
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to report characteristics and outcomes of surgical excision of symptomatic mature posttraumatic myositis ossificans in adult athletes. The hypothesis was that surgical excision of the ossified mass in these circumstances can effectively relief symptoms and result in return to high-level sports with minimal postoperative complications.

Methods

All operations involving excision of posttraumatic heterotopic ossifications performed between 1987 and 2015 were reviewed. Included cases had isolated excision of posttraumatic myositis ossificans, whereas excluded cases had: (1) concomitant reattachment of tendon to bone; (2) chronic overuse injuries which preceded the development of the heterotopic mass or large calcifications which were excised from tendon-to-bone insertions; and (3) excision of heterotopic ossification from a ligament, capsule, or tendon insertion following avulsion injury without tendon-to-bone repair. After surgery, return to sports was allowed at 4–6 weeks.

Results

Of 57 athletes undergoing excision of heterotopic ossifications, 32 were eligible as isolated excision of posttraumatic myositis ossificans. Twenty-four (75%) were ice hockey or soccer players. Median age was 23 years. Prior to surgery, patients were unable to continue their sports. At surgery, the ossification was excised from a thigh muscle in 27 (84%) cases. Median follow-up was 2 years (range 1–20 years). Outcome was Good/Excellent in 26 (81%) patients, corresponding to return to preinjury sports with minimal symptoms at sports activities. Preinjury Tegner activity level was resumed after surgery in 30 of 32 (94%) athletes, of whom 28 (94%) were involved in high-level sports corresponding to Tegner levels 8–10. No postoperative complications were recorded other than minimal insensitive areas at the periphery of skin incisions.

Conclusion

In high-level athletes who present chronic disabling mature posttraumatic myositis ossificans that interferes with their sports career, surgical excision of the heterotopic mass results in effective clinical improvement with return to sports and minimal postoperative risks.

Level of evidence

Case series, Level IV.

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Authors and Affiliations

  1. Sports Injury Research Center, Hospital NEO, Turku, Finland

    Sakari Orava, Janne Sarimo & Lasse Lempainen

  2. Department of Pediatric Surgery and Orthopedics, Oulu University Hospital, Oulu, Finland

    Juha-Jaakko Sinikumpu

  3. Pedego Research Group, MRC, Oulu University, Oulu, Finland

    Juha-Jaakko Sinikumpu

  4. Mehiläinen Sports Clinic, Oulu, Finland

    Juha-Jaakko Sinikumpu

  5. Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Gideon Mann & Iftach Hetsroni

Authors
  1. Sakari Orava
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  2. Juha-Jaakko Sinikumpu
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  3. Janne Sarimo
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  4. Lasse Lempainen
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  5. Gideon Mann
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  6. Iftach Hetsroni
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Corresponding author

Correspondence to Iftach Hetsroni.

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Conflict of interest

All authors declare that they do not have any conflict of interests related to this article.

Funding

This study did not receive any specific grant or any funding from any funding agency.

Ethical approval

The local hospital ethics committee (Hospital NEO, Turku, Finland) approved the study protocol on 16 September 2016. It includes only retrospective data obtained from hospital databases and did not require any patient to sign informed consent form.

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Orava, S., Sinikumpu, JJ., Sarimo, J. et al. Surgical excision of symptomatic mature posttraumatic myositis ossificans: characteristics and outcomes in 32 athletes. Knee Surg Sports Traumatol Arthrosc 25, 3961–3968 (2017). https://doi.org/10.1007/s00167-017-4667-7

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  • DOI: https://doi.org/10.1007/s00167-017-4667-7

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