Medial tibial stress syndrome and bone marrow edmea

NewsBot · Apr 23, 2012

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A prospective study on MRI findings and prognostic factors in athletes with MTSS
M. H. Moen, S. L. Schmikli, et al
Scandinavian Journal of Medicine & Science in Sports 20 APR 2012

In medial tibial stress syndrome (MTSS) bone marrow and periosteal edema of the tibia on the magnetic resonance imaging (MRI) is frequently reported. The relationship between these MRI findings and recovery has not been previously studied. This prospective study describes MRI findings of 52 athletes with MTSS. Baseline characteristics were recorded and recovery was related to these parameters and MRI findings to examine for prognostic factors. Results showed that 43.5% of the symptomatic legs showed bone marrow or periosteal edema. Absence of periosteal and bone marrow edema on MRI was associated with longer recovery (P = 0.033 and P = 0.013). A clinical scoring system for sports activity (SARS score) was significantly higher in the presence of bone marrow edema (P = 0.027). When clinical scoring systems (SARS score and the Lower Extremity Functional Scale) were combined in a model, time to recovery could be predicted substantially (explaining 54% of variance, P = 0.006). In conclusion, in athletes with MTSS, bone marrow or periosteal edema is seen on MRI in 43,5% of the symptomatic legs. Furthermore, periosteal and bone marrow edema on MRI and clinical scoring systems are prognostic factors. Future studies should focus on MRI findings in symptomatic MTSS and compare these with a matched control group.
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Admin2 · Apr 23, 2012

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NewsBot · Apr 5, 2016

Increased density and periosteal expansion of the tibia in young adult men following short-term arduous training
Rachel M. Izard et al
Bone; 31 March 2016

Highlights
•Early functional adaptations of human bone occur with short-term weight-bearing arduous training.
•The changes in bone in response to training are specific to the site of loading, bone surface and regional sector.
•Functional adaptations of bone in response to weight-bearing arduous exercise may be close to the fracture threshold in some individuals.
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Purpose
Few human studies have reported early structural adaptations of bone to weight-bearing exercise, which provide a greater contribution to improved bone strength than increased density. This prospective study examined site- and regional-specific adaptations of the tibia during arduous training in a cohort of male military (infantry) recruits to better understand how bone responds in vivo to mechanical loading.

Methods
Tibial bone density and geometry were measured in 90 British Army male recruits (ages 21 ? 3 years, height: 1.78 ? 0.06 m, body mass: 73.9 ? 9.8 kg) in weeks 1 (Baseline) and 10 of initial military training. Scans were performed at the 4%, 14%, 38% and 66% sites, measured from the distal end plate, using pQCT (XCT2000L, Stratec Pforzheim, Germany). Customised software (BAMPack, L-3 ATI) was used to examine whole bone cross-section and regional sectors. T-tests determined significant differences between time points (P < 0.05).

Results
Bone density of trabecular and cortical compartments increased significantly at all measured sites. Bone geometry (cortical area and thickness) and bone strength (i, MMi and BSI) at the diaphyseal sites (38 and 66%) were also significantly higher in week 10. Regional changes in density and geometry were largely observed in the anterior, medial–anterior and anterior–posterior sectors. Calf muscle density and area (66% site) increased significantly at week 10 (P < 0.01).

Conclusions
In vivo mechanical loading improves bone strength of the human tibia by increased density and periosteal expansion, which varies by site and region of the bone. These changes may occur in response to the nature and distribution of forces originating from bending, torsional and shear stresses of military training. These improvements are observed early in training when the osteogenic stimulus is sufficient, which may be close to the fracture threshold in some individuals.
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NewsBot · Oct 6, 2019

Does tibial bone mineral status quality differ between medial tibial stress syndrome symptomatic and asymptomatic long-distance runners?
J. Mattock et al
October 2019Volume 22, Supplement 2, Page S20

Introduction: Medial tibial stress syndrome (MTSS) is an overuse injury that predominately affects runners and military personal. MTSS is thought to be caused by a bone stress reaction, whereby bony adaptations of the tibia cannot keep pace with repetitive loading of the lower limb. Although tibial bone density has been implicated in the development of MTSS, whether it is a cause or effect remains unclear. Therefore, the aim of this study was to determine whether tibial bone mineral status (BMS) differed between active MTSS symptomatic and asymptomatic long-distance runners, as well as to present a prospective case study, to determine the role BMS plays in the development of MTSS.

Methods: Nine MTSS symptomatic long-distance runners (2 males; age = 34.5 ± 13.5 years; mass = 67.05 ± 11.5 kg; height = 1.71 ± 0.08 m) were matched on gender, age, body mass, running experience and training load with nine asymptomatic controls (2 males; age = 35.4 ± 12.6 years; mass = 67.4 ± 15.1 kg; height = 1.72 ± 0.18 m). All participants ran at least 30 km per week or were training for a long-distance event within 6 months prior to testing. BMS was assessed using quantitative-ultrasound (QUS) to calculate raw speed of sound measures (SOS) for each participant. Independent-samples t-tests were used to identify any significant (p≤0.05) between-group differences in BMS. One male participant (age = 28.8 years; mass = 78.06 kg; height = 1.91 m) developed bilateral MTSS symptoms during the study and is presented as a longitudinal case study with t-scores calculated from QUS measurements pre- and post-MTSS injury. Paired samples t-tests were used to identify significant difference between BMS pre- and post-injury.

Results: There was no significant difference in BMS between MTSS symptomatic and asymptomatic participants (p = 0.253). However, asymptomatic participants displayed, on average, a greater BMS SOS score (4058.78 ± 82 m/s) compared to the symptomatic participants (4009 ± 93 m/s). For the case study, the pre-injury BMS t-scores were, on average, greater (0.025 ± 0.74 SD) than the post-injury levels (-0.17 ± 0.56 SD), although this difference was not statistically significant (p = 0.382).

Discussion: The lack of significant differences in BMS between the two participant groups and in the case study suggest that BMS is not a causative factor in the development of MTSS. Furthermore, these findings indicate that continued tibial loading by MTSS symptomatic distance runners allows positive tibial adaptation and BMS maintenance. The findings from this study highlight the importance of continued weight bearing activity in the management of MTSS to maintain bone density.
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