Estimation of return-to-sports-time for athletes with stress fracture – an approach combining risk level of fracture site with severity based on imagingReportar como inadecuado

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BMC Musculoskeletal Disorders

, 13:139

First Online: 06 August 2012Received: 11 January 2012Accepted: 30 July 2012


BackgroundThe aim was to compare the return-to-sports-time RTST following stress fractures on the basis of site and severity of injury. This retrospective study was set up at a single institution. Diagnosis was confirmed by an interdisciplinary adjudication panel and images were rated in a blinded-read setting.

Methods52 athletes female, n = 30; male, n = 22; mean age, 22.8 years with stress fracture SFX who had undergone at least one examination, either MRI or bone scintigraphy, were included. Magnetic resonance images MRI and-or bone scintigraphy BS of SFX were classified as either low- or high-grade SFX, according to existing grading systems. For MRI, high-grade SFX was defined as visibility of a fracture line or bone marrow edema in T1-, T2-weighted and short tau inversion recovery STIR sequences, with low-grade SFX showing no fracture line and bone marrow edema only in STIR and-or T2-weighted sequences. In BS images, a mild and poorly defined focal tracer uptake represented a low-grade lesion, whereas an intense and sharply marginated uptake marked a high-grade SFX. In addition, all injuries were categorized by location as high- or low-risk stress fractures. RTST was obtained from the clinical records. All patients were treated according to a non-weight-bearing treatment plan and comprehensive follow-up data was complete until full recovery. Two-sided Wilcoxon’s rank sum test was used for group comparisons.

ResultsHigh-risk SFX had a mean RTST of 132 days d IQR 64d – 132d compared to 119d IQR 50d – 110d for low-risk sites p = 0.19. RTST was significantly longer p = 0.01 in high-grade lesions mean, 143d; IQR 66d – 134d than in low-grade mean, 95d; IQR 42d – 94d. Analysis of high-risk SFX showed no difference in RTST p = 0.45 between high- and low-grade mean, 131d; IQR 72d – 123d vs. mean, 135d; IQR 63d – 132d. In contrast, the difference was significant for low-risk SFX p = 0.005 low-grade; mean, 61d; IQR 35d – 78d vs. high-grade; mean, 153d; IQR 64d – 164d.

ConclusionFor SFX at low-risk sites, the significant difference in RTST between low- and high-grade lesions allows more accurate estimation of RTST by this approach. Both location of the injury and severity determined by imaging should therefore be considered for prediction of RTST.

KeywordsStress fracture Grading system Athletes MRI Bone scintigraphy AbbreviationsRTSTReturn-To-Sports-Time

SFXStress Fracture

BSBone Scintigraphy-Bone Scan

MRIMagnetic Resonance Imaging



IQRInter Quartile Range

STIRShort Tau Inversion Recovery



Electronic supplementary materialThe online version of this article doi:10.1186-1471-2474-13-139 contains supplementary material, which is available to authorized users.

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