Bone marrow oedema syndrome of the foot and ankle in a paediatric population: a retrospective case series with serial MRI evaluation.

PURPOSE: By means of a case series we wanted to describe and correlate the clinical and imaging features of bone marrow oedema syndrome (BMOS) of the foot and ankle in children. METHODS: A retrospective data study was performed on patients born on or after 01 January 2001 who underwent multiple MRI scans of the foot and ankle for pain symptoms. Six patients who presented with increased signal intensity on T2-weighted MR imaging without any underlying causes or concomitant pathology were included. RESULTS: All patients, three boys and three girls with a mean age of 11 years (8 to 14), displayed patchy areas of increased signal intensity on T2-weighted and turbo inversion recovery magnitude (TIRM) images. On average, six tarsal bones were involved (4 to 8). In all patients, treatment consisted of rest and/or protected weight-bearing. The mean time for symptoms to improve during treatment was 6 months (1 to 16). The mean duration of treatment was nine months (3 to 16). In all patients clinical and imaging symptoms were strongly correlated and regressed in time. CONCLUSION: BMOS as a pathological entity should be considered in paediatric patients with foot and ankle pain without a clear underlying cause, and characteristic T2-weighted and TIRM signal intensity increase on MRI images. As BMOS is transient and self-limiting, conservative treatment is advised while the oedema regresses. An early diagnosis of this pathology could prevent unnecessary diagnostic investigations and invasive treatments. LEVEL OF EVIDENCE: IV.

Prepatellar Friction Syndrome: a common cause of knee pain in the elite cyclist.

BACKGROUND: Although anterior knee pain is extremely common in high-level road cyclists, the exact etiology still remains unclear. METHODS: A group of 28 professional male elite cyclists diagnosed with Prepatellar Friction Syndrome (PPFS) were retrospectively reviewed with specific attention for the typical history, clinical findings and treatment modalities. RESULTS: A traumatic onset of the complaints was reported by 10 athletes, while the complaints were caused by chronic overuse in the remaining 18 subjects. Conservative treatment delivered poor results and all cases were eventually treated surgically. Surgery confirmed macroscopic damage to at least one prepatellar fascial layer in all patients, after which partial fasciectomy was performed through a mini incision. CONCLUSION: PPFS is a new clinical entity of the triple-layered prepatellar fascial structures. Correct diagnosis is critical and based on the typical history and clinical findings. Partial prepatellar fasciectomy is the treatment of choice in order to regain the pre-injury performance level.