Feasibility of MR-guided high intensity focused ultrasound treatment of tibial stress syndrome

Zielsetzung Evaluation preliminary efficacy and safety of MR-guided high intensity focused ultrasound (MRgFUS) treatment of tibial stress syndrome (TSS).

Material und Methoden Patients treated with MRgFUS (INSIGHTEC ExAblate 2100) for painful bone conditions were screened retrospectively for TSS. Inclusion criteria include: (1) exercise-induced chronic lower leg pain, (2) periosteal/cortical thickening with associated focal bone marrow edema, (3) location in the posteromedial middle/distal third of the tibia. Patients with fracture or tumor were excluded. Technique, results and complications of MRgFUS were analyzed.

Ergebnisse Three professional athletes (ageavg: 18±2,3 years) discontinued their training because of chronic TSS. MRgFUS was performed under general anesthesia. Initial therapy used a mean of 2.3±0.6 sonications with 352±83 Joule (J). Two patients were re-treated using 6.5±3.5 sonications with 578±217 J at 12 and 15 months post-MRgFUS due to symptom relapse. No complications occurred. All patients had subjective clinical improvement and clearly reduced edema in follow-up MRI; periosteal thickening appeared unchanged. All resumed their normal activities.

Schlussfolgerungen TSS is a common exercise-induced leg pain syndrome (incidence 4-35%). It is often managed conservatively, but prolonged symptoms are typical. Different therapies have been evaluated for further management, either with no effect or poor study design (M. Winters, 2019; M. Winters et al., 2013; N. Reshef et al., 2012). MRgFUS offers a promising treatment option for TSS. It is non-invasive, non-toxic and has been proven to palliate other painful bone conditions (e.g. bone tumors, osteoid osteoma). Despite close proximity to skin, ablation was safely performed. Initially lower energy was focused on the main TSS-area for a more conservative approach. Covering the entire bone surface adjacent to edema was pursued with an increased learning curve. All patients resumed their athletic activities after MRgFUS.

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Artikel online veröffentlicht:
13. April 2023