Location
Philadelphia, PA
Start Date
1-5-2024 1:00 PM
End Date
1-5-2024 4:00 PM
Description
I. Introduction
Tibial stress fractures are common overuse injuries that are a source of pain, disability, and missed time from athletic activity. There are established protocols currently for return-to-play programs, but little consensus on the use of adjunctive modalities during the recovery period to reduce the recovery period. The purpose of this review is to summarize the results of randomized controlled literature evaluating the effectiveness of modalities to reduce time to healing in posteromedial tibial stress fractures.
II. Methods
A systematic search of PubMed, EMBASE, and Google Scholar was conducted between September 2022 and July 2023, following PRISMA guidelines. The authors independently screened the title and abstracts of each article. Those articles chosen for full-text review were independently analyzed, and an inclusion or exclusion decision was made in a blinded fashion. The final list of publications was then analyzed for bias by each author independently utilizing the Jadad scoring system.
III. Results
Six randomized controlled trials met the inclusion criteria. These trials studied a total of four modalities: pneumatic leg bracing, pulsed ultrasound therapy, laser therapy, and capacitively coupled electric field stimulation. Pneumatic bracing was studied in two trials with a median time to healing of 21
2 days versus 77 7 days in one trial (p < 0.001) and 37.2 13.2 days versus 45.6 20.9 days (p > 0.24) in the second trial. Pulsed ultrasound therapy was also studied in two trials with a median return to play of 25.46 3.84 days versus 39.93 5.36 days in the first trial (p < 0.001) and 56.2 19.6 days versus 55.5 15.5 days in the second trial (p > 0.05). Laser therapy was associated with 91% recovery at 21 days of treatment versus 56% in the control group (p > 0.05). Lastly, capacitively coupled electric field stimulation was associated with a return to play of 29 15.8 days versus 25.9 13.5 (p > 0.05).
IV. Discussion
This systematic review demonstrates the potential benefits of a number of nonoperative modalities to treat tibial stress fractures. Pneumatic leg bracing was associated with a reduction in time to healing. However, poor compliance with treatment hindered the results of the second trial. Similarly, electrical field stimulation can shorten healing time only in patients with adequate compliance to treatment; otherwise, no difference between groups was found. Ultrasound therapy yielded mixed results due to heterogeneity in the ultrasound protocols across studies. A non-statistically significant reduction in healing time was observed with the use of laser therapy in a trial with small a sample size and a short duration of follow-up. The overall effectiveness of the modalities in these six trials remains undefined due to significant trial limitations, including small sample sizes, high dropout rates, and poor patient compliance. The clinical utility of these modalities is dependent on patient compliance, preference, and availability of the intervention. More robust trials are needed to determine the effectiveness of each of these modalities.
Embargo Period
6-17-2024
Included in
Adjunctive therapies in the management of tibial stress fractures: A systematic review of the literature
Philadelphia, PA
I. Introduction
Tibial stress fractures are common overuse injuries that are a source of pain, disability, and missed time from athletic activity. There are established protocols currently for return-to-play programs, but little consensus on the use of adjunctive modalities during the recovery period to reduce the recovery period. The purpose of this review is to summarize the results of randomized controlled literature evaluating the effectiveness of modalities to reduce time to healing in posteromedial tibial stress fractures.
II. Methods
A systematic search of PubMed, EMBASE, and Google Scholar was conducted between September 2022 and July 2023, following PRISMA guidelines. The authors independently screened the title and abstracts of each article. Those articles chosen for full-text review were independently analyzed, and an inclusion or exclusion decision was made in a blinded fashion. The final list of publications was then analyzed for bias by each author independently utilizing the Jadad scoring system.
III. Results
Six randomized controlled trials met the inclusion criteria. These trials studied a total of four modalities: pneumatic leg bracing, pulsed ultrasound therapy, laser therapy, and capacitively coupled electric field stimulation. Pneumatic bracing was studied in two trials with a median time to healing of 21
2 days versus 77 7 days in one trial (p < 0.001) and 37.2 13.2 days versus 45.6 20.9 days (p > 0.24) in the second trial. Pulsed ultrasound therapy was also studied in two trials with a median return to play of 25.46 3.84 days versus 39.93 5.36 days in the first trial (p < 0.001) and 56.2 19.6 days versus 55.5 15.5 days in the second trial (p > 0.05). Laser therapy was associated with 91% recovery at 21 days of treatment versus 56% in the control group (p > 0.05). Lastly, capacitively coupled electric field stimulation was associated with a return to play of 29 15.8 days versus 25.9 13.5 (p > 0.05).
IV. Discussion
This systematic review demonstrates the potential benefits of a number of nonoperative modalities to treat tibial stress fractures. Pneumatic leg bracing was associated with a reduction in time to healing. However, poor compliance with treatment hindered the results of the second trial. Similarly, electrical field stimulation can shorten healing time only in patients with adequate compliance to treatment; otherwise, no difference between groups was found. Ultrasound therapy yielded mixed results due to heterogeneity in the ultrasound protocols across studies. A non-statistically significant reduction in healing time was observed with the use of laser therapy in a trial with small a sample size and a short duration of follow-up. The overall effectiveness of the modalities in these six trials remains undefined due to significant trial limitations, including small sample sizes, high dropout rates, and poor patient compliance. The clinical utility of these modalities is dependent on patient compliance, preference, and availability of the intervention. More robust trials are needed to determine the effectiveness of each of these modalities.