Periosteal and tendinous edema not associated with medial tibial stress syndrome

NewsBot · Jul 19, 2016

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Are ultrasonographic findings like periosteal and tendinous edema associated with medial tibial stress syndrome? A case-control study
Marinus Winters, Paulien Bon, Sascha Bijvoet, Eric W.P. Bakker, Maarten Moen
JSAMS; In Press

Objectives
Medial tibial stress syndrome (MTSS) is one of the most common sporting injuries. As of yet, the development of effective therapeutic interventions to treat MTSS is hindered by the fact that its pathology is unknown. Our aim was to explore the pathology of MTSS, by assessing whether the presence of MTSS is related to periosteal, bony or tendinous abnormalities in the lower leg.
Design
Case-control study.
Methods
Participants with MTSS and athletic control participants were recruited from the same (high-risk) base population. Musculoskeletal ultrasonography was performed on the posteromedial tibial border and deep plantar flexor muscles by an experienced radiological specialist who was blinded to group membership. Associations between MTSS and tissue abnormalities were expressed in odds ratios (OR).
Results
A total of 42 participants, 15 MTSS cases and 27 control athletes completed the study. Overall, periosteal and tendinous abnormalities were common in cases with and without MTSS. Periosteal edema was present in 8 (53.3%) MTSS cases and in 10 (37.0%) control athletes, in specific painful spots in the distal 2/3 of the posteromedial tibial border OR = 1.9 (95% CI 0.54 − 6.99, p = 0.35). Also, tendinous abnormalities in the tibialis posterior muscle were frequently seen in MTSS cases (N = 7, 46.7%) and in control athletes (N = 13, 48.1%) (OR = 0.97, 95% CI 0.27-3.51, p = 0.96). No bone abnormalities were observed in either group.
Conclusions
Periosteal and tendinous findings seem to be common in both athletes with and without MTSS, and consequently are not associated with MTSS.
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Admin2 · Jul 19, 2016

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NewsBot · Aug 6, 2018

Microcrack-associated bone remodeling is rarely observed in biopsies from athletes with medial tibial stress syndrome
Marinus WintersDavid B. BurrHenk van der HoevenKeith W. CondonJohan BellemansMaarten H. Moen
Journal of Bone and Mineral Metabolism: 31 July 2018

The pathology of medial tibial stress syndrome (MTSS) is unknown. Studies suggest that MTSS is a bony overload injury, but histological evidence is sparse. The presence of microdamage, and its potential association with targeted remodeling, could provide evidence for the pathogenesis of MTSS. Understanding the pathology underlying MTSS could contribute to effective preventative and therapeutic interventions for MTSS. Our aim was to retrospectively evaluate biopsies, previously taken from the painful area in athletes with MTSS, for the presence of linear microcracks, diffuse microdamage and remodeling. Biopsies, previously taken from athletes with MTSS, were evaluated at the Department of Anatomy and Cell Biology at the Indiana University. After preparing the specimens by en bloc staining, one investigator evaluated the presence of linear microcracks, diffuse microdamage and remodeling in the specimens. A total of six biopsies were evaluated for the presence of microdamage and remodeling. Linear microcracks were found in 4 out of 6 biopsies. Cracking in one of these specimens was artefactual due to the biopsy procedure. No diffuse microdamage was seen in any of the specimens, and only one potential remodeling front in association with the microcracks. We found only linear microcracks in vivo in biopsies taken from the painful area in 50% of the athletes with MTSS, consistent with the relationship between linear cracks and fatigue-associated overloading of bone. The nearly universal absence of a repair reaction was notable. This suggests that unrepaired microdamage accumulation may underlie the pathophysiological basis for MTSS in athletes.
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