Stress fracture risk factors in soccer players: A systematic review

Abstract

Background:This study conducted a systematic review to evaluate stress fracture risk factors in soccer players, aiming to enhance injury prevention strategies.Methods:We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, focusing on professional soccer players. Database searches (Medline, Scopus, CENTRAL, Embase, and Web of Science) used predefined terms in November 2024. Bias assessment employed Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument tools, and descriptive synthesis was used due to limited meta-analyzable data.Results:Our systematic review analyzed 26 studies with 8514 participants. Young age was a risk factor in four studies, and female gender in one. High body mass index, increased training hours, competitions, and intense preseason training also raised risk. Anatomical factors included lower calcaneal pitch angle, wider medial malleolar slip angle, higher Talocalcaneal angle, and lower limb varus malalignment. Stress fractures were higher among midfielders in one study, while two others found no positional differences. Additional risks were elevated parathyroid hormone, higher bone-specific alkaline phosphatase, lower 25OH levels, fasting, and perceived stress from negative life events.Conclusions:Soccer players face a heightened risk of stress fractures due to the repetitive forces involved in the sport, a significant concern given its global popularity. Although this review identified several risk factors, ongoing controversies remain, primarily due to the limited number of studies and the complex, multifactorial nature of stress fractures.