Subscribe to RSS
DOI: 10.1055/a-2013-2226
Asymptomatic Bone Marrow Edema in Weight-bearing Bones in Athletes and Military Trainees: A Systematic Literature Review
![](https://www.thieme-connect.de/media/sportsmed/202310/lookinside/thumbnails/9707_10-1055-a-2013-2226-1.jpg)
Abstract
Asymptomatic bone marrow edema (aBME) is a non-specific radiographic finding often found in athletes. Although aBME may represent the body's physiological response to training load, the etiology, MRI characteristics, and natural history of aBME remain unknown. To better characterize aBME in the lower extremities of military trainees and athletes. A systematic literature review in accordance with PRISMA guidelines was performed to identify primary research articles reporting on aBME in the lower extremities of athletes and military trainees. We identified 347 unique articles and after applying inclusion and exclusion criteria, 10 articles were included for qualitative synthesis. There were a total of 444 patients with an average age of 28.4±9.6 included. The most commonly used MRI sequences were proton-density with fat-saturation and T1-weighted imaging. The pattern of BME was inconsistently described, with various classification schemas used. The changes in aBME during longitudinal follow-up were dynamic and demonstrated both radiographic progression and regression. aBME is a highly prevalent and radiographically dynamic entity observed in high-level athletes and military trainees. Although follow-up was limited in the included studies, aBME may represent a natural, non-pathologic, reaction in response to specific biomechanical stressors.
Publication History
Received: 13 August 2022
Accepted: 03 January 2023
Article published online:
01 June 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart,
Germany
-
References
- 1 Kubo T, Yamamoto T, Inoue S. et al. Histological findings of bone marrow edema pattern on MRI in osteonecrosis of the femoral head. J Orthop Sci 2000; 5: 520-523
- 2 Manara M, Varenna M.. A clinical overview of bone marrow edema. Reumatismo 2014; 66: 184-196
- 3 Vande Berg BC, Lecouvet FE, Koutaissoff S. et al. Bone marrow edema of the femoral head and transient osteoporosis of the hip. Eur J Radiol 2008; 67: 68-77
- 4 Maraghelli D, Brandi ML, Matucci Cerinic M. et al. Edema-like marrow signal intensity: a narrative review with a pictorial essay. Skeletal Radiol 2021; 50: 645-663
- 5 Harlow ER, Khambete P, Ina J. et al. Prevalence of asymptomatic bone marrow edema in the talus in professional ballet dancers: Preliminary data from 2-year prospective study. Foot Ankle Orthop 2022; 7 2473011421S00226
- 6 Tenforde AS, Outerleys J, Bouxsein ML. et al. Metatarsal bone marrow edema on magnetic resonance imaging and its correlation to bone stress injuries in male collegiate basketball players. Orthop J Sports Med 2022; 10 23259671211063504
- 7 Varkas G, de Hooge M, Renson T. et al. Effect of mechanical stress on magnetic resonance imaging of the sacroiliac joints: Assessment of military recruits by magnetic resonance imaging study. Rheumatology (Oxford) 2018; 57: 508-513
- 8 Fredericson M, Bergman AG, Hoffman KL. et al. Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med 1995; 23: 472-481
- 9 Nattiv A, Kennedy G, Barrack MT. et al. Correlation of MRI grading of bone stress injuries with clinical risk factors and return to play: a 5-year prospective study in collegiate track and field athletes. Am J Sports Med 2013; 41: 1930-1941
- 10 Baumbach SF, Pfahler V, Bechtold-Dalla Pozza S. et al. How We Manage Bone Marrow Edema-An Interdisciplinary Approach. J Clin Med 2020; 9: 551
- 11 Lazzarini KM, Troiano RN, Smith RC.. Can running cause the appearance of marrow edema on MR images of the foot and ankle?. Radiology 1997; 202: 540-542
- 12 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021; 372: n71
- 13 Munn Z, Barker TH, Moola S. et al. Methodological quality of case series studies: An introduction to the JBI critical appraisal tool. JBI Evid Synth 2020; 18: 2127-2133
- 14 Horga LM, Henckel J, Fotiadou A. et al. Can marathon running improve knee damage of middle-aged adults? A prospective cohort study. BMJ Open Sport Exerc Med 2019; 5: e000586
- 15 Kornaat PR, van de Velde SK.. Bone marrow edema lesions in the professional runner. Am J Sports Med 2014; 42: 1242-1246
- 16 Major NM, Helms CA.. MR imaging of the knee: findings in asymptomatic collegiate basketball players. AJR Am J Roentgenol 2002; 179: 641-644
- 17 Yao W, Zhang Y, Zhang L. et al. MRI features of and factors related to ankle injuries in asymptomatic amateur marathon runners. Skeletal Radiol 2021; 50: 87-95
- 18 Bezuglov E, Khaitin V, Lazarev A. et al. Asymptomatic foot and ankle abnormalities in elite professional soccer players. Orthop J Sports Med 2021; 9 2325967120979994
- 19 Hadid A, Moran DS, Evans RK. et al. Tibial stress changes in new combat recruits for special forces: Patterns and timing at MR imaging. Radiology 2014; 273: 483-490
- 20 Horga LM, Henckel J, Fotiadou A. et al. Magnetic resonance imaging of the hips of runners before and after their first marathon run: Effect of training for and completing a marathon. Orthop J Sports Med 2021; 9 23259671211010404
- 21 Mandalia V, Williams C, Kosy J. et al. Bone marrow oedema in the knees of asymptomatic high-level athletes: Prevalence and associated factors. Indian J Orthop 2020; 54: 324-331
- 22 Noyes FR, Stabler CL.. A system for grading articular cartilage lesions at arthroscopy. Am J Sports Med 1989; 17: 505-513
- 23 Bray TJP, Sakai N, Dudek A. et al. Histographic analysis of oedema and fat in inflamed bone marrow based on quantitative MRI. Eur Radiol 2020; 30: 5099-5109
- 24 Kox LS, Kraan RBJ, Mazzoli V. et al. It’s a thin line: Development and validation of Dixon MRI-based semi-quantitative assessment of stress-related bone marrow edema in the wrists of young gymnasts and non-gymnasts. Eur Radiol 2020; 30: 1534-1543
- 25 Li X, Yu A, Virayavanich W. et al. Quantitative characterization of bone marrow edema pattern in rheumatoid arthritis using 3 Tesla MRI. J Magn Reson Imaging 2012; 35: 211-217
- 26 Foti G, Mantovani W, Faccioli N. et al. Identification of bone marrow edema of the knee: Diagnostic accuracy of dual-energy CT in comparison with MRI. Radiol Med 2021; 126: 405-413
- 27 Arendt E, Agel J, Heikes C. et al. Stress injuries to bone in college athletes: A retrospective review of experience at a single institution. Am J Sports Med 2003; 31: 959-968
- 28 Davis IS, Bowser BJ, Mullineaux DR.. Greater vertical impact loading in female runners with medically diagnosed injuries: a prospective investigation. Br J Sports Med 2016; 50: 887-892