Fredericson MRI classification of medial tibial stress syndrome
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medial tibial stress syndrome
The Fredericson MTSS classification follows a progression related to the extent of injury. This begins with periosteal edema (grade 1), followed by progressive marrow involvement (grades 2 and 3), and eventually cortical stress fracture (grades 4a and 4b).
MRI classification of MTSS is an accurate way to correlate the extent of bone involvement with clinical symptoms, which leads to more accurate recommendations for rehab and return to sports activity.
The estimated delay in returning to impact activity based on this classification is2:
- Grade 1: 2-3 weeks
- Grades 2-4a: 6-7 weeks
- Grade 4b: 9-10 weeks or more
- 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. 23 (4): 472-81. - Pubmed citation
- Kijowski R, Choi J, Shinki K et-al. Validation of MRI classification system for tibial stress injuries. AJR Am J Roentgenol. 2012;198 (4): 878-84. AJR Am J Roentgenol (full text) - doi:10.2214/AJR.11.6826 - Pubmed citation