Stress Fractures (Stress Fracture)

Fractures due to the strain caused by repetitive exercise. They are thought to arise from a combination of MUSCLE FATIGUE and bone failure, and occur in situations where BONE REMODELING predominates over repair. The most common sites of stress fractures are the METATARSUS; FIBULA; TIBIA; and FEMORAL NECK.

Also Known As:

Stress Fracture; Fracture, Fatigue; Fatigue Fracture; Fractures, Stress; Bone Stress Reaction; Insufficiency Fractures; Micro Fractures; Microfractures; Stress Reaction, Bone; Bone Stress Reactions; Fracture, Insufficiency; Fracture, March; Fracture, Micro; Fracture, Stress; Fractures, Micro; Insufficiency Fracture; March Fracture; March Fractures; Micro Fracture; Microfracture; Fatigue Fractures; Fractures, Fatigue; Fractures, March

Networked: 2838 relevant articles (121 outcomes, 314 trials/studies)

Relationship Network

Disease Context: Research Results

Wounds and Injuries: 176426
- Bone Fractures: 3857
  - Stress Fractures: 2838

Related Diseases

1.	Pain (Aches)
2.	Osteoarthritis
3.	Knee Osteoarthritis
4.	Knee Injuries (Knee Injury)
5.	Wounds and Injuries (Trauma)

Experts

1.	Cole, Brian J: 18 articles (01/2022 - 11/2009)
2.	McClung, James P: 14 articles (01/2022 - 12/2007)
3.	Krych, Aaron J: 14 articles (12/2021 - 06/2012)
4.	Saris, Daniel B F: 10 articles (12/2021 - 02/2008)
5.	Madry, Henning: 10 articles (04/2021 - 11/2012)
6.	Yamamoto, Takuaki: 10 articles (09/2017 - 04/2005)
7.	Iwamoto, Yukihide: 9 articles (01/2022 - 04/2005)
8.	Maffulli, Nicola: 9 articles (01/2022 - 05/2010)
9.	Stuart, Michael J: 9 articles (12/2021 - 05/2014)
10.	Williams, Riley J: 9 articles (12/2021 - 09/2005)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Stress Fractures:

1.	Hyaluronic Acid (Hyaluronan)IBA 10/01/2013 - "The current study reveals that application of hyaluronan after the microfracture might be beneficial in inducing articular cartilage defect reparation." 06/01/2009 - "In conclusion, a combination of the microfracture technique and application of hyaluronic acid might be potentially beneficial in inducing articular cartilage defect reparation." 01/01/2020 - "Aim: This study aimed to preliminarily evaluate the safety and efficacy of human adipose-derived mesenchymal progenitor cells (haMPCs) in combination with microfracture and hyaluronic acid (HA) for treating cartilage defects. " 01/01/2017 - "To determine the clinical and radiographic efficacy of hyaluronic acid-based cell-free scaffold applied in combination with microfracture versus microfracture alone in patients with focal osteochondral lesion of the knee joint. " 04/01/2009 - "The efficacy of intra-articular hyaluronan injection after the microfracture technique for the treatment of articular cartilage lesions."
2.	Vitamin D FDA LinkGeneric 05/01/2018 - "While no significant relationship was found between vitamin D level and fracture history, patients with a history of stress fracture had significantly greater mean vitamin D levels. " 05/01/2018 - "Contrary to our hypothesis, players with a history of stress fracture had a significantly greater mean vitamin D level than those without such history (30.7 vs 25.1 ng/mL; P = .04). " 12/01/2020 - "The rate of stress fracture was 12% higher (95% CI, 6-19; P < .001) for those who remained low in vitamin D compared with those who were low at baseline but improved their vitamin D status to ≥40 ng/mL. The rate of stress fracture was also 12% higher (95% CI, 5-18; P < .001) for those who had low vitamin D levels compared with those who maintained normal levels. " 12/01/2020 - "We assessed differences in the rate of stress fracture among those who maintained or improved vitamin D levels to ≥40 ng/mL and those who did not, as well as differences in average baseline vitamin D levels by sport type (indoor vs outdoor). " 06/01/2020 - "Vitamin D for Improved Bone Health and Prevention of Stress Fractures: A Review of the Literature."
3.	Teriparatide (Parathar)FDA Link 08/30/2021 - "This study will evaluate whether teriparatide, in addition to standard care, is more effective for stress fracture healing than standard care alone in Army recruits who have sustained a lower body stress fracture. " 08/30/2021 - "Teriparatide and stress fracture healing in young adults (RETURN - Research on Efficacy of Teriparatide Use in the Return of recruits to Normal duty): study protocol for a randomised controlled trial." 01/01/2017 - "This study aimed to evaluate the efficacy of teriparatide in patients with sacral insufficiency fractures. " 02/01/2016 - "Teriparatide may assist healing of stress fractures and improvement in bone matrix composition. " 08/30/2021 - "In a two-arm, parallel, prospective, randomised controlled, intention-to-treat trial, Army recruits (n = 136 men and women, 18-40 years) with a magnetic resonance imaging (MRI) diagnosed lower body stress fracture (pelvic girdle, sacrum, coccyx, or lower limb) will be randomised to receive either usual Army standard care, or teriparatide and usual Army standard care. "
4.	HydrogelsIBA 10/01/2023 - "It is hypothesized that HA-hydrogel-augmented microfracture (MFX) is superior to MFX in enhancing early cartilage repair, and that the molar degree of substitution and concentration of HA affects repair. " 12/15/2022 - "The modulus (618.44 kPa, 67.6 times), fracture stress (1054.59 kPa, 25.3 times), and toughness (6.23 MJ m-3, 41.7 times) of the composite hydrogels were greatly improved without affecting the tensile properties (fracture strain, ~1000 %). " 10/01/2020 - "This assessor-blinded trial evaluates ChonDux hydrogel scaffold implantation in combination with microfracture in 18 patients across 6 sites. " 01/08/2020 - "Furthermore, an in vivo study indicated that the formation of a healthy hyaline cartilage after the microfracture was enhanced by the fabricated hydrogel implant, offering a potential biocompatible platform for microfracture-based cartilage reconstructive surgery." 01/01/2019 - "Our study demonstrated high patient satisfaction rates after microfractures combined with a modern hydrogel scaffold; histologic evaluation supported the hypothesis of creating an enhanced chondrogenic environment. "
5.	CollagenIBA 01/01/2022 - "Third-Generation Autologous Chondrocyte Implantation (Cells Cultured Within Collagen Membrane) Is Superior to Microfracture for Focal Chondral Defects of the Knee Joint: Systematic Review and Meta-analysis." 11/22/2017 - "Microfracture surgery may be improved by the implantation of unidirectional collagen scaffolds that provide a template for mesenchymal stem cells to regenerate cartilage. " 04/20/2020 - "In this study Autologous Matrix Induced Chondrogenesis (AMIC), combining subchondral microfractures with a collagen membrane (type I and III collagen), was used in the treatment of isolated patellar cartilage defects. " 01/01/2020 - "The purpose of this study was to evaluate the clinical efficacy and safety of treating patients with a cartilage defect of the knee with microfractures and porcine-derived collagen-augmented chondrogenesis technique (C-ACT). " 09/01/2019 - "It appears that for defects as treated in this study, it is not worthwhile adding the collagen I/III matrix to the microfractures. "
6.	Collagen Type II (Type II Collagen)IBA 10/01/2013 - "Mixed type I and type II collagen scaffold for cartilage repair: ultrastructural study of synovial membrane response and healing potential versus microfractures (a pilot study)." 12/01/2018 - "The expression of type II collagen appeared almost 10 times higher with our approach compared to normal microfracture, indicating the potential to overcome the fibro-cartilage formation associated with the current microfracture approach. " 03/01/2017 - "Conclusion Nanofracture provided better repair tissue than microfracture, with a more satisfactory cartilage architecture renovation and tissue having greater type II collagen content. " 01/01/2017 - "Histological analysis revealed that the reparative tissue induced by microfracture with scSOX9 had features of hyaline cartilage; and collagen type II to type I ratio was similar to that in normal cartilage. " 07/01/2011 - "A biochemical assay, real-time polymerase chain reaction assay and Western blot analysis all revealed that the long-term delivery of BMP-2 group had the highest glucosaminoglycan content as well as the highest expression level of collagen type II. Taken together, the long-term delivery of BMP-2 to cartilage defects subjected to microfracture resulted in regeneration of hyaline-like cartilage, as opposed to short-term delivery or no BMP-2 delivery. "
7.	CalciumIBA 09/01/2007 - "More study is needed of the associations between stress fracture and age, calcium intake, and age at menarche. " 02/01/2020 - "In HypoPT, resistance to microfracture is decreased and may be associated with greater supplemental calcium doses and might increase with PTH replacement. " 02/01/2017 - "Risk factors were cumulative when predicting low BMD (including <85% expected weight, weekly mileage >30, stress fracture history and <1 serving of calcium-rich food/day): 0-1 risk factors (11.1%), 2 risk factors (42.9%), or 3-4 risk factors (80.0%), p<0.001). " 10/01/2012 - "Servings of milk during middle-school years were positively correlated with hip BMD, although current calcium intake, low BMD, irregular menstrual history, hard training surface, and long history of training duration were the most important predictors of stress fractures." 07/01/2012 - "Neither calcium intake nor dairy intake was prospectively associated with stress fracture risk."
8.	ChitosanIBA 07/01/2020 - "We prospectively report chitosan blood implant with microfracture results in patients with recalcitrant talar OCLs who were previously treated with microfracture alone in a single-surgeon study. " 12/01/2021 - "Treating full-thickness patellofemoral osteochondral lesions with microfractures associated with a chitosan scaffold proved to be effective regarding defect filling and symptomatic improvement." 12/01/2021 - "To assess the clinical and radiological results of patellofemoral osteochondral lesions treated with microfractures associated with a chitosan scaffold. " 12/01/2021 - "Treatment of Patellofemoral Chondral Lesions Using Microfractures Associated with a Chitosan Scaffold: Mid-Term Clinical and Radiological Results." 02/18/2021 - "The enhancement of cartilage regeneration by use of a chitosan-based scaffold in a 3D model of microfracture in vitro: a pilot evaluation."
9.	Biocompatible Materials (Biomaterials)IBA 06/01/2015 - "Autologous matrix-induced chondrogenesis (AMIC), using microfracture and biomaterials, has shown promising results for the treatment of knee osteochondral lesions and has been proposed for the ankle as an open technique. " 06/02/2021 - "Together, this study suggests that the sE-Col scaffold holds great potential in developing the one-step microfracture-based strategy for cartilage repair and also reminds us that despite dECM being a promising biomaterial in tissue engineering, the optimization of the proper processing methodology would be a crucial consideration in the future design of dECM-based scaffolds in articular cartilage regeneration." 09/01/2018 - "A multilayer biomaterial for osteochondral regeneration shows superiority vs microfractures for the treatment of osteochondral lesions in a multicentre randomized trial at 2 years." 05/01/2010 - "Our study showed that biomaterial-augmented microfracture is a viable option in cartilage repair from a biological perspective because adult femoral MPC have a strong capacity to differentiate into chondrocytes, which is further enhanced by the surrounding cartilage. " 05/08/2022 - "One promising method for cartilage regeneration involves combining known methods, such as the microfracture technique with biomaterials, e.g., scaffolds (membranes). "
10.	Parathyroid Hormone (Parathormone)IBA 02/01/2010 - "Deleterious effects of intermittent recombinant parathyroid hormone on cartilage formation in a rabbit microfracture model: a preliminary study." 08/01/2021 - "Refractory Tibial Insufficiency Fracture Nonunion Healed with Parathyroid Hormone Level Correction: A Case Report." 06/01/2017 - "To evaluate clinical features and the effect of parathyroid hormone (PTH) on treatment outcomes of patients with pelvic insufficiency fractures. " 11/01/2014 - "Periods of activity with repetitive mechanical loading, such as military training, may result in increases in parathyroid hormone (PTH), a key regulator of Ca metabolism, and may be linked to the development of stress fractures. " 11/01/2012 - "We present two cases of pelvic insufficiency fracture in elderly patients which had good clinical outcome by parathyroid hormone 1-34(teriparatide) treatment as well as a literature review. "

Therapies and Procedures

1.	Debridement 01/01/2021 - "After arthroscopic debridement of an OLT without drilling or microfracture, there was a high rate of return to the NBA, with improved points scored, assists, and steals made after surgery when compared with preoperative performance. " 01/01/2016 - "This systematic review showed that arthroscopic debridement, microfracture, and ACT are associated with equivalent improvement in clinical outcomes in patients with high-grade chondral defects in the hip in the short- and midterm follow-up. " 01/01/2022 - "The arthroscopic microfracture for the treatment of osteochondral lesion of talus is superior to joint debridement in terms of improving ankle function, especially in relatively young men with a relatively low BMI." 11/01/2009 - "Debridement and/or microfracture are often initial surgical interventions; these procedures can be expected to provide functional improvement in over 50%, but studies suggest that the amount of improvement deteriorates within 3 years. " 10/01/2018 - "Arthroscopic debridement and microfracture for advanced capitellar OCD result in improved (ie, decreased) defect size at a mean follow-up of 29 months, both in width and in depth. "
2.	Transplantation 01/01/2020 - "Among them, osteochondral autograft transplantation and 2-step procedures such as autologous chondrocyte implantation have provided good results, promoting formation of new hyaline-like cartilage tissue, whereas other techniques such as microfracture result in fibrous cartilage and a less durable repair. " 06/01/2018 - "Microfracture, autologous chondrocyte transplantation, and direct chondral repair, among others, are techniques that have shown good results in some cases. " 04/01/2016 - "Osteochondral autograft transplantation and ACI had statistically significantly greater rates of return to sports compared with microfracture (P < .001, P < .01; Fisher exact test). " 12/01/2019 - "To investigate the efficacy of the transplantation of autologous bone marrow-derived mesenchymal stem cells (BMSCs) under arthroscopy with microfracture (MFX) compared with microfracture alone. " 05/01/2015 - "Matrix-assisted articular chondrocyte transplantation consistently showed improved patient-reported functional outcomes compared with microfracture (p values ranging from < 0.001 to 0.029). "
3.	Therapeutics 03/01/2018 - "Considered by some experts to be the gold standard therapy, microfracture is one of the most common procedures used for cartilage restoration. " 05/01/2019 - "In conclusion, this case demonstrates that MTX discontinuation/replacement in combination with an individualized and state-of-the-art bone-specific therapy is effective in SLE patients with stress fractures after long-term MTX use." 08/07/2008 - "This suggests that the clinical outcome of patients undergoing microfracture therapy could be improved. " 01/01/2023 - "The study demonstrated that hUCB-MSC therapy was cost effective compared with microfracture when treating patients with knee OA. " 03/01/2017 - "Short-term results from United States Food and Drug Administration (FDA) phase I and phase II clinical trials indicated that the NeoCart implant was safe when surgically applied as a cell-based therapy and efficacious compared with microfracture. "
4.	Osteotomy 12/01/2010 - "We asked whether a transtrochanteric rotational osteotomy for a subchondral insufficiency fracture of the femoral head in young adults would (1) provide improvement in functional scores; and (2) lead to healing of the fractures. " 09/01/2022 - "The aims of this study were to characterize the incidence and risk factors associated with stress fractures following periacetabular osteotomy, and to determine their effect on osteotomy union. " 10/16/2021 - "This study evaluated the regenerated cartilage after opening-wedge high tibial osteotomy (OWHTO) with concomitant microfracture by second-look arthroscopy, Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score and magnetic resonance imaging (MRI) T2 mapping. " 10/16/2021 - "Evaluation of regenerated cartilage using T2 mapping methods after opening-wedge high tibial osteotomy with microfracture at the cartilage defect: a preliminary study." 05/01/2023 - "This is the first report of the transposition osteotomy of the acetabulum for a subchondral fatigue fracture of the femoral head with acetabular dysplasia. "
5.	Injections 01/01/2002 - "To those cases arthroscopic microfracture method and succeeding intraarticular hyaulonic injections revealed good results." 10/01/2022 - "Future trials regarding the combination of microfracture and PRP in treatment of OLT should focus on the efficacy of longer term, intra-articular, serial injections of PRP instead of single injections." 10/01/2013 - "to assess the efficacy of associating the microfracture technique with platelet-rich plasma (PRP) injections in the treatment of chondral lesions to promote acceleration and optimization of the healing process compared with the traditional microfracture approach. " 12/18/2015 - "The aim of this paper is to describe the methodology of a pilot randomised controlled trial comparing arthroscopic microfracture alone for isolated knee chondral defects versus arthroscopic microfracture combined with postoperative autologous adipose derived mesenchymal stem cell injections. " 10/01/2013 - "Comments on "Repeated platelet concentrate injections enhance reparative response of microfractures in the treatment of chondral defects of the knee: an experimental study in an animal model" by Milano et al."