Determination of safe return to play for athletes recovering from infectious mononucleosis: a review of the literature.

OBJECTIVE: Infectious mononucleosis is an acute self-limited disorder diagnosed by clinical and hematologic measures. This paper reviews the literature regarding the decision-making process for return to play in individuals at risk for complications due to infectious mononucleosis.

DATA SOURCES: Computerized literature search identified articles using the keywords infectious mononucleosis, athlete, injury, exercise, spleen rupture, and spleen radiography. Symptoms, physical examination, hematological markers, and radiographic evaluation were considered.

CONCLUSIONS: No strong evidence-based information supports use of a single parameter to predict the safe return to sports participation. Current consensus supports that athletes be afebrile, well hydrated, and asymptomatic with no palpable liver or spleen. Clinical judgment incorporating these criteria 1 month after diagnosis has been suggested as a safe predictor for gradual return to competition. These conditions for return to play do not guarantee that the spleen has returned to normal size and compliance, or that the risk of spleen rupture has returned to baseline. For those athletes participating in contact sports who wish to return to sports in an earlier time frame, or those with an equivocal examination, radiographic modalities may be used to help determine liver and spleen size. Further studies are required to support this practice.