Stress fractures are small cracks in the bone, usually caused by overuse from repetitive activity. The wear and injury in the bone exceeds the bone’s ability to heal and repair itself, resulting in breakdown of the bone and a stress or fatigue fracture.
What Is a Stress Fracture About the Knee?
A stress fracture occurs when repetitive activity causes breakdown of bone tissue faster than the bone can heal and repair itself. Continued activity before the breakdown can be repaired can lead to further inflammation, bone injury, and pain.
Causes and Risk Factors
Stress fractures are caused by overuse from repetitive activity.
Risk factors include:
- Sports that require repetitive loading or running, such as marathon running, soccer, walking, and jogging
- Running on uneven terrain or hard surfaces, such as concrete
- Poor physical conditioning, including strength and flexibility
- Lack of conditioning early in the season or practice
- Poor running technique
- A sudden change in activity level, distance, intensity, or running surface
- Premature weight bearing after surgery
Symptoms
Common signs and symptoms include:
- Deep thigh pain, particularly when walking
- Pain at night, particularly after a day with increased activity
- With continued activity and no treatment, constant pain that may eventually cause an athlete to stop participating in sports
Treatment
Conservative treatment consists of a period of non-weight bearing followed by a gradual return to activity once pain has subsided. Referral to a physical therapist or athletic trainer is often recommended.
For patients with persistent symptoms, including swelling, pain, and functional limitations, despite conservative treatment and with a significant stress reaction identified on MRI, surgery to promote healing of the damaged bone is usually recommended.
The first line of operative treatment usually involves arthroscopic surgery to evaluate the joint and assess the integrity of the cartilage surface. A percutaneous drilling procedure is then performed using small pins in the area of bone affected by the stress injury. Drilling stimulates bleeding in the area to promote healing.
Recovery and Outcomes
Appropriate treatment can improve symptoms, including swelling, pain, and functional limitations, and allow a gradual return to activity. When identified early and treated correctly, the condition may resolve within a matter of weeks. More severe cases may take up to a few months.
Following the restorative surgical procedure, extensive rehabilitation is required. This includes an initial six-week period of non-weight bearing followed by gentle passive movement of the joint, range-of-motion exercises, stretching, and strengthening of the joint and surrounding muscles. Assistance from a physical therapist is typically required, with at least three to six months before return to athletic activities.
Potential complications include:
- Recurrence of symptoms, resulting in persistent pain and swelling
- Progression to a complete and displaced fracture
- Risks of surgery, including infection, bleeding, injury to nerves resulting in numbness, weakness, or paralysis, and the need for further surgery
When to See Dr. Chudik
Schedule an evaluation if knee or proximal tibia pain has developed gradually with training and has persisted beyond two to three weeks, particularly in runners or military recruits. Call 630-324-0402 or request an appointment online.