Radiological healing of lumbar spine stress fractures in elite cricket fast bowlers

Singh, Simran Preet; Rotstein, Andrew; Saw, Anna E; Saw, Richard; Kountouris, Alex; James, Trefor

doi:10.1016/j.jsams.2020.06.018

Cited by 6 publications

(12 citation statements)

References 18 publications

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“…Healing was observed in approximately 87% of cases, strengthening the findings of 81% 16 and 62% 18 on subsets of the cases included in this study. Similar rates of healing were observed between LBSI which recurred and those which did not.…”

Section: Discussionsupporting

confidence: 85%

“…Healing of complete stress fractures was lowest with a proportion of approximately 53%. Based on the bone remodeling process and previous research in a similar cohort which showed larger fractures take longer to heal, 16 insufficient healing time before returning to bowling may be suspected as a key factor. This is supported by the finding in this study of similar return to bowling times for complete stress fractures compared with incomplete stress fractures and stress reactions.…”

Section: Discussionmentioning

confidence: 99%

“…These findings are consistent with bone healing times in a subset of cases included in this study which were found to be shorter for less severe LBSI (less bone marrow edema and/or smaller fracture size) and new LBSI compared with recurrent LBSI. 16 The consistency of these findings may be explained by the bone remodeling process, and also how MRI is used in practice for elite Australian cricket players, whereby MRI screening is used strategically to detect early (presymptomatic) LBSI, and serial MRI are used to monitor bone healing post-LBSI to inform return to bowling times. Nevertheless, it is important to note the large variability in return to bowling times which reflects the individual management of LBSI, which remains the recommended approach rather than prescriptive time frames.…”

Section: Discussionmentioning

confidence: 99%

“…1,15 The healing status of LBSI can also be assessed with MRI. 1,16,17 The use of diagnostic, screening, and healing MRI enables additional insight into the etiology and management of LBSI and nonunited defects in elite cricket players.…”

Section: Introductionmentioning

confidence: 99%

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Lumbar Bone Stress Injuries and Nonunited Defects in Elite Australian Cricket Players

Saw

Eales²,

Jones

et al. 2023

Clinical Journal of Sport Medicine

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Objective: To describe the presentation and management of lumbar bone stress injuries (LBSI), recurrent LBSI, and lumbar nonunited defects in elite Australian male and female cricket players. Design: Retrospective case series. Setting: Professional domestic and international cricket teams over 13 seasons. Participants: Elite Australian cricket players. Independent variables: Symptomatic LBSI requiring time off cricket and lumbar nonunited defects, both confirmed by imaging. Main outcome measures: Incidence, presentation, history, healing, and management. Results: 211 LBSI were identified at an average incidence of 5.4 per 100 players per season. LBSI were most common in male pace bowlers younger than 20 years of age (58.1 per 100 players per season), however, were also observed in older players, females, and non-pace bowlers. Recurrent LBSI accounted for 33% (27%-40%) of all LBSI. Median days to return to match availability was 182 (128-251) days for all LBSI, with a shorter time frame observed for new and less severe injuries, and male spin bowlers. Healing was demonstrated in 87% (81%-91%) of all LBSI cases. 29 nonunited defects were identified and predisposed subsequent pain, LBSI, and spondylolisthesis. Conclusions: LBSI are experienced by approximately 5.4 in every 100 elite Australian cricket players per season, with a high time cost of approximately 4 to 8 months. Nonunited defects also have a high time cost with associated subsequent lumbar spine issues. The findings of this study reinforce the importance of early detection and conservative management of LBSI, particularly for younger male pace bowlers and players with recurrent LBSI, which may be supported by MRI.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Lumbar Bone Stress Injuries and Nonunited Defects in Elite Australian Cricket Players

Saw

Eales²,

Jones

et al. 2023

Clinical Journal of Sport Medicine

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“…Following stress fracture, repair of the fracture site is initiated by woven bone formation followed by bone remodelling 19 , and can take in excess of 6 months to achieve complete healing to restore union 20 . Rehabilitation from LSF in cricket fast bowlers is comprised of periods of rest, strength and conditioning, and gradual reintroduction to fast bowling.…”

Section: Introductionmentioning

confidence: 99%

Activity specific areal bone mineral density is reduced in athletes with stress fracture and requires profound recovery time: A study of lumbar stress fracture in elite cricket fast bowlers

Alway

Peirce²,

Johnson³

et al. 2022

Journal of Science and Medicine in Sport

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L5 spondylolysis: Anatomical study comparing healed and unhealed lesions

et al. 2023

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The anatomy and pathogenesis of spondylolysis has been widely studied; however, the microanatomy of spondylolysis of the lumbar vertebra has not been well described. Therefore, we aim to better elucidate this anatomy. Twenty dry bone specimens of healed and unhealed spondylolysis of the L5 vertebra were collected from human skeletal remains. Twelve L5 vertebrae were examples of unhealed spondylolysis and eight specimens exhibited a healed (i.e., bony fusion of the lesion) spondylolysis lesion. The specimens underwent macro and microanatomical analysis followed by CT and microCT imaging. Finally, selected healed and unhealed lesions were submitted for histological analysis using Mason Trichrome staining. The pars interarticularis of two L5 vertebrae without signs of healed/unhealed spondylolysis were evaluated histologically as controls. Of the 12 unhealed L5 pars defects, three were unilateral on left side. Of the eight healed pars defects, all were unilateral and seven of these were on left sides. One unilateral pars defect also had spina bifida occulta. Both on imaging and histological analysis, healed pars defects were only so superficially and not at deeper levels. Histologically, unhealed edges were made up of dense cortical bone while healed edges were made up primarily of trabecular bone. Based on our anatomical findings, the so‐called healed spondylolysis lesions, although externally fused, are not thoroughly fused internally. Moreover, the anterior and posterior edges of the unhealed spondylosysis lesions are irregular and show signs of long‐term disarticulation. Taken together, these data suggest that such ‘healed’ lesions might not be as stable as the normal L5 pars interarticularis.

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Radiological healing of lumbar spine stress fractures in elite cricket fast bowlers

Cited by 6 publications

References 18 publications

Lumbar Bone Stress Injuries and Nonunited Defects in Elite Australian Cricket Players

Lumbar Bone Stress Injuries and Nonunited Defects in Elite Australian Cricket Players

Activity specific areal bone mineral density is reduced in athletes with stress fracture and requires profound recovery time: A study of lumbar stress fracture in elite cricket fast bowlers

L5 spondylolysis: Anatomical study comparing healed and unhealed lesions

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