Medial tibial plateau morphology and stress fracture location: A magnetic resonance imaging study

Yukata, Kiminori; Yamanaka, Issei; Ueda, Yoshisuke; Nakai, Sho; Ogasa, Hiroyoshi; Oishi, Yosuke; Hoshino, Junichi

doi:10.5312/wjo.v8.i6.484

Cited by 11 publications

(15 citation statements)

References 16 publications

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“…Other factors such as surgery for anterior cruciate ligament reconstruction (14) and unicompartmental knee arthroplasty (15,16), drug-induced osteoporosis (17,18), and even primary and postpartum osteoporosis without BP use (19,20) can also cause these fractures. Generally, medial tibial plateau stress fractures can be managed conservatively simply by the cessation of sports activity, and symptoms usually resolve within two months (12,13,21). We treated this patient with a lateral wedge insole and protective weight-bearing with a T-cane, but this case had a concomitant lateral tibial plateau fracture, and further resulted in a delayed healing.…”

Section: Discussionmentioning

confidence: 99%

“…In such a BP-related atypical insufficiency fracture, early short-term casting and / or knee supporter might be considered to prevent delayed union and deformity of the fracture site. In addition, MRI-STIR images are the most useful investigative tool when the index of suspicion is high (21,22). Since X-ray changes are quite subtle during the period of prodromal pain, we recommend using MRI to investigate patients treated long-term with BP.…”

Section: Discussionmentioning

confidence: 99%

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Bisphosphonate-related atypical insufficiency fracture of the tibial plateau : A case report

et al. 2021

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Objective : Only a few cases of insufficiency fractures of the tibial plateau following bisphosphonate use have been reported. The authors report a case with bisphosphonate (BP) -related atypical insufficiency fracture of tibial plateau, which developed delayed union. Patient : A 65-year-old Japanese woman presented with left knee pain without any trauma. She had a 5-year history of risedronate use for primary osteoporosis. Initial X-rays were unremarkable, but magnetic resonance imaging (MRI) confirmed an insufficiency fracture at the left tibial plateau at 3 weeks after the initial visit. Risedronate treatment was stopped because we diagnosed her with a BP-related atypical insufficiency fracture of the tibial plateau. She was treated with rest, a lateral wedge insole and protective weight-bearing with a T-cane for 3 months. Result : At 3-month follow-up, the patient still had a pain and a delayed healing on radiographs. Six months later, X-rays showed that the fracture site had a sclerotic change, but MRI revealed delayed union. At 8-month follow-up, the fracture was healed without any symptoms. Conclusion : All clinicians need to be aware of the delayed healing of atypical insufficiency fracture related with prolonged BP use.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bisphosphonate-related atypical insufficiency fracture of the tibial plateau : A case report

et al. 2021

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“…A tíbia é o osso mais afetado por fraturas por estresse, especialmente em corredores de longa distância. A diáfise da tíbia é o local mais comum, enquanto as lesões na metáfise proximal da tíbia são raras (1)(2)(3) . Estudos descrevem alta incidência de bilateralidade nas fraturas por estresse da tíbia proximal (6)(7) .…”

Section: Discussionunclassified

“…Essa lesão pode ser facilmente confundida com outros diagnósticos diferencias, justamente porque o local de dor e sensibilidade a palpação é muito semelhante a lesões meniscais e tendinite da pata de ganso, que são lesões comuns em pacientes corredores. A suspeita clínica é essencial para o diagnóstico correto (1)(2)(3) .…”

Section: Introductionunclassified

Cuidado com o diagnóstico clínico da tendinite da para de ganso em corredores recraacionais: pode se fratura por estresse no planalto tibial medial. Relato de dois casos

Netto

Rodrigues

Garotti

2021

Arq Med Hosp Fac Cienc Med Santa Casa São Paulo

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Introdução: O diagnóstico de fratura por estresse no planalto tibial medial pode ser confundida com outros diagnósticosdiferencias, justamente porque o local de dor e sensibilidade a palpação é muito semelhante a lesões meniscais e tendiniteda pata de ganso, que são lesões comuns em pacientes corredores. Objetivo: Relatar dois casos que foram interpretadosinicialmente como tendinite na pata de ganso na avaliação inicial, e após reavaliação ambulatorial, foi realizado diagnósticode fratura por estresse bilateral no planalto tibial medial. Relato dos Casos: Duas pacientes do sexo feminino, 31 e 32 anos respectivamente, começaram a prática de corrida de rua, sem supervisão, e seis e oito semanas após o início da prática, evoluíram com dor nos joelhos, bilateralmente, na face medial. Na avaliação inicial o quadro foi interpretado como tendinite da pata de ganso. Como não tiveram melhora, procuraram novo atendimento médico, em que foi feito suspeita diagnóstica de fratura por estresse no planalto tibial medial, e foram solicitados exames de ressonância magnética bilateral, que confirmaram o diagnóstico. Ambas as pacientes foram tratadas de forma conservadora, com restrição para atividades de impacto por 6 semanas, carga conforme dor, analgesia simples com dipirona, gelo, e ibandronato sódico por 2 meses. As pacientes retornaram após 6 semanas com melhora clínica. Após sessões de fisioterapia foram liberadas para atividades de impacto com sucesso. Conclusão: Esses casos enfatizam a importância da suspeita diagnóstica de fratura por estresse no planalto tibial medial em pacientes corredores recreacionais com quadro de dor na região medial do joelho, principalmente se houve uma mudança no seu padrão ou intensidade de corrida. Palavras chave: Joelho, Fratura por estresse, Fraturas da tíbia

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“…In addition, studies [ 34 ] have shown that the bone mineral density of the medial tibial plateau is lower than that of the lateral side, which is one of the reasons that the medial side is more vulnerable. Yukata et al [ 35 ] studied stress fractures of the tibial plateau and found that all stress fractures occurred in the medial plateau and that the fracture location was related to the posterior tilt of the medial tibial plateau. In our study, we found that in the knee longitudinal collision injury test, a longitudinal low-speed impact often led to an inner knee injury and a high-speed collision often resulted in both medial and lateral knee injuries.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Responses and Injury Characteristics of Knee Joints under Longitudinal Impacts of Different Velocities

Xiong

Zhao

Xiang

et al. 2018

Applied Bionics and Biomechanics

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Background and Objective Knee joint collision injuries occur frequently in military and civilian scenarios, but there are few studies assessing longitudinal impacts on knee joints. In this study, the mechanical responses and damage characteristics of knee longitudinal collisions were investigated by finite element analysis and human knee impact tests. Materials and methods Based on a biocollision test plateau, longitudinal impact experiments were performed on 4 human knee joints (2 in the left knee and 2 in the right knee) to measure the impact force and stress response of the bone. And then a finite element model of knee joint was established from the Chinese Visible Human (CVH), with which longitudinal impacts to the knee joint were simulated, in which the stress response was determined. The injury response of the knee joint-sustained longitudinal impacts was analyzed from both the experimental model and finite element analysis. Results The impact experiments and finite element simulation found that low-speed impact mainly led to medial injuries and high-speed impact led to both medial and lateral injuries. In the knee joint impact experiment, the peak flexion angles were 13.8° ± 1.2, 30.2° ± 5.1, and 92.9° ± 5.45 and the angular velocities were 344.2 ± 30.8 rad/s, 1510.8 ± 252.5 rad/s, and 9290 ± 545 rad/s at impact velocities 2.5 km/h, 5 km/h, and 8 km/h, respectively. When the impact velocity was 8 km/h, 1 knee had a femoral condylar fracture and 3 knees had medial tibial plateau fractures or collapse fractures. The finite element simulation of knee joints found that medial cortical bone stress appeared earlier than the lateral peak and that the medial bone stress concentration was more obvious when the knee was longitudinally impacted. Conclusion Both the experiment and FE model confirmed that the biomechanical characteristics of the injured femur and medial tibia are likely to be damaged in a longitudinal impact, which is of great significance for the prevention and treatment of longitudinal impact injuries of the knee joint.

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Medial tibial plateau morphology and stress fracture location: A magnetic resonance imaging study

Cited by 11 publications

References 16 publications

Bisphosphonate-related atypical insufficiency fracture of the tibial plateau : A case report

Bisphosphonate-related atypical insufficiency fracture of the tibial plateau : A case report

Cuidado com o diagnóstico clínico da tendinite da para de ganso em corredores recraacionais: pode se fratura por estresse no planalto tibial medial. Relato de dois casos

Biomechanical Responses and Injury Characteristics of Knee Joints under Longitudinal Impacts of Different Velocities

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