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2015 ; 6
(8
): 577-89
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Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and
future developments
#MMPMID26396934
Franklyn M
; Oakes B
World J Orthop
2015[Sep]; 6
(8
): 577-89
PMID26396934
show ga
Medial tibial stress syndrome (MTSS) is a debilitating overuse injury of the
tibia sustained by individuals who perform recurrent impact exercise such as
athletes and military recruits. Characterised by diffuse tibial anteromedial or
posteromedial surface subcutaneous periostitis, in most cases it is also an
injury involving underlying cortical bone microtrauma, although it is not clear
if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and
magnetic resonance imaging (MRI) can both be used for the diagnosis of MTSS, but
the patient's history and clinical symptoms need to be considered in conjunction
with the imaging findings for a correct interpretation of the results, as both
imaging modalities have demonstrated positive findings in the absence of injury.
However, MRI is rapidly becoming the preferred imaging modality for the diagnosis
of bone stress injuries. It can also be used for the early diagnosis of MTSS, as
the developing periosteal oedema can be identified. Retrospective studies have
demonstrated that MTSS patients have lower bone mineral density (BMD) at the
injury site than exercising controls, and preliminary data indicates the BMD is
lower in MTSS subjects than tibial stress fracture (TSF) subjects. The values of
a number of tibial geometric parameters such as cross-sectional area and section
modulus are also lower in MTSS subjects than exercising controls, but not as low
as the values in TSF subjects. Thus, the balance between BMD and cortical bone
geometry may predict an individual's likelihood of developing MTSS. However,
prospective longitudinal studies are needed to determine how these factors alter
during the development of the injury and to find the detailed structural cause,
which is still unknown. Finite element analysis has recently been used to examine
the mechanisms involved in tibial stress injuries and offer a promising future
tool to understand the mechanisms involved in MTSS. Contemporary accurate
diagnosis of either MTSS or a TSF includes a thorough clinical examination to
identify signs of bone stress injury and to exclude other pathologies. This
should be followed by an MRI study of the whole tibia. The cause of the injury
should be established and addressed in order to facilitate healing and prevent
future re-occurrence.
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