American Medical Society of Sports Medicine Position Statement: Mononucleosis and Athletic Participation
Putukian M, McGrew CA, Benjamin HJ, Hammell MK, Hwang CE, Ray JW, Statuta SM, Sylvester J, Wilson K. Clin J Sport Med. 2023 May 15. doi: 10.1097/JSM.0000000000001161. Epub ahead of print. PMID: 37186809.
The American Medical Society for Sports Medicine updated a 2008 position statement on mononucleosis and athletic participation. The authors review the epidemiology, clinical manifestations, laboratory assessment, and management including return to sport for the athlete with infectious mononucleosis. They also address complications, imaging, special considerations, diversity and equity considerations, and areas for future clinical research. Table 1 offers a summary of 8 key points.
My name is Patrick Cline, and I benefited a lot from reading this updated position statement. I found it enlightening to read about the variability that’s present in multiple aspects of treating mononucleosis and how it can seriously complicate the RTP decisions that sports medicine personnel are faced with. I expanded my understanding of what the roughly established best practice guidelines are for treatment of different varieties of patients and dispelled some common misconceptions about their RTP timelines. Most shocking to me in this article was the study that showed that among 142 participants, baseline splenic volumes could vary by up to 1,400 mL! without baseline testing for each of their athletes, it is impossible for clinicians to make decisions based on splenic enlargement measures when natural splenic volume varies that much. My biggest take away from this article was that it is necessary to use a shared-decision model in an individualized approach to each case in order to make any return to sport decisions. The pathology is just so variable that trying to establish a universal, clear-cut return to activity program is not a realistic option. I hope that in time research will continue to expand our knowledge of this elusive disease.