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Fredericson MRI classification of medial tibial stress syndrome

Case contributed by Dr Matt Skalski

Fredericson classification

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).

Case Discussion

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
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Case information

rID: 21292
Published: 14th Jan 2013
Last edited: 14th Aug 2019
Inclusion in quiz mode: Excluded
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