Performance Impact and Limited Return-to-Play Rates Following Ankle Fractures in National Hockey League Players

Research Type: Level 4 – Case series Introduction/Purpose: Ankle fractures are an uncommon but significant injury in professional hockey players, potentially affecting their performance and career longevity. This study aimed to assess the demographics, mechanisms of injury, treatment approaches, and both short- and long-term performance metrics in NHL players following ankle fractures. Methods: A retrospective cohort analysis was conducted on NHL players who sustained ankle fractures from 2008 to 2024. Data were collected from various sources, including NHL injury databases and media reports, and included player demographics, injury mechanism, treatment, and post-injury performance metrics. Demographic data, mechanisms of injury, timing, and treatment methods were collected. Player performance was assessed across two seasons: pre-injury and post-injury, with metrics including goals, assists, total points, and plus-minus rating. Data were analyzed for statistically significant differences between the two periods. Results: The cohort consisted of 30 NHL players with a mean age of 26.6 ± 5.1 years. Defensemen experienced the largest proportion of ankle fractures of all positions (46.7%), and these happened almost entirely in-season (96.7%). The predominant mechanisms of injury included contact with boards or net (26.7%) and contact with other players (23.3%). Surgical intervention was required in 30% of cases, while 70% were treated non-surgically. The return to play rate was 68.2%, with a mean return to play time of 1.8 months. Players experienced significant declines in performance post-injury: goals (p=0.006), assists (p=0.003), and total points (p=0.003) decreased by approximately 50%. Despite the decrease in offensive statistics, there was no significant change in time on ice per game (p=0.124). Conclusion: NHL players who sustain ankle fractures demonstrate a significant decline in performance metrics post-injury, particularly in offensive contributions. Despite a relatively quick return to play, the long-term impact of ankle fractures on player performance warrants consideration in managing these injuries. Further research is needed to explore rehabilitation protocols that may mitigate these performance losses.