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Microcrack-associated bone remodeling is rarely observed in biopsies from athletes with medial tibial stress syndrome

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Abstract

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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Funding

This research did not receive any specific Grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, 9220, Aalborg, Denmark

    Marinus Winters

  2. Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, USA

    David B. Burr & Keith W. Condon

  3. Department of Biomedical Engineering, Indiana University-Purdue University, Indianapolis, USA

    David B. Burr

  4. Bergman Clinics, Naarden, The Netherlands

    Henk van der Hoeven & Maarten H. Moen

  5. Department of Orthopedics, University Hasselt, ZOL Hospital Genk, Genk, Belgium

    Johan Bellemans

  6. The Sportsphysician Group, OLVG Hospital Amsterdam, Amsterdam, The Netherlands

    Maarten H. Moen

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  1. Marinus Winters
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  3. Henk van der Hoeven
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  4. Keith W. Condon
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Correspondence to Marinus Winters.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Winters, M., Burr, D.B., van der Hoeven, H. et al. Microcrack-associated bone remodeling is rarely observed in biopsies from athletes with medial tibial stress syndrome. J Bone Miner Metab 37, 496–502 (2019). https://doi.org/10.1007/s00774-018-0945-9

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  • DOI: https://doi.org/10.1007/s00774-018-0945-9

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