Which sport disciplines other than diving are associated with the emergence of aseptic osteonecrosis? A narrative review.

UNLABELLED: The aim of the present work was to review the current literature about sport disciplines other than diving which are associated with the emergence of aseptic osteonecrosis, identify the possible causative mechanisms, and analyze the diagnostic modalities and treatment options. A literature search was performed through PubMed and Google Scholar until December 2024. Search terms were "sport" in combination with "osteonecrosis", and "bone necrosis", respectively. A total of 23 studies reporting on a total of 54 cases (56 affected bones) could be identified. No study was published before 1983. All studies had a level of evidence IV. Twenty-six different sport disciplines have been described. The most frequent discipline identified was gymnastics being reported in 20 cases. Ball activities were observed in 17 cases with soccer and tennis being the most frequent described disciplines. In approximately half of the affected bones (25/56), the osteonecrosis was localised in the wrist/hand, or the femoral head, respectively. Among the wrist and hand bones, the lunate bone was predominantly affected. Regarding the cases affecting the wrist and hand bones, the great majority of the patients performed sports activities associated with direct or indirect forces (e.g. fencing, handball, volleyball, shot-put, weightlifting, archery, varsity football) or martial-arts sports (karate, kung-fu, aikido, kendo). At the site of femoral head osteonecrosis, 11 different sport activities have been described, whereby gymnastics were associated with more than half of the cases (15/26). Regarding the return to sport activities, approximately half of all identified cases (29/54) were able to return partly or completely to the initially practised sport disciplines or new ones after conservative or surgical treatment. A large variety of sports disciplines have been associated with the emergence of aseptic osteonecrosis. Athletes, parents, coaches, and physicians should be alarmed especially when children and adolescents complain about persistent bone and/or joint pain, and initiate further diagnostic measures.

LEVEL OF EVIDENCE: IV.