Proposed Modified Bone Stress Injury Classification Score.

Area of Science:

• Orthopedics
• Sports Medicine
• Radiology

Background:

• Numerous bone stress injury (BSI) classification systems exist, but most rely solely on imaging.
• Clinical risk factors are crucial for predicting return-to-running timelines but are often overlooked in current BSI scoring.
• Existing systems lack comprehensive integration of clinical and imaging data for BSI severity.

Purpose of the Study:

• To develop and validate a modified BSI classification score.
• Incorporate clinical factors, bone location, MRI grading, and bone type into a novel scoring system.
• Enhance prediction accuracy for return-to-running times in athletes with BSIs.

Main Methods:

• A 7-year prospective cohort study of NCAA Division I track and field athletes (2013-2020).
• Collected data on risk factors, BSIs, and return-to-running times through questionnaires, interviews, and medical records.
• Developed a 0-7 modified BSI score combining Cumulative Risk Assessment (CRA) category, bone location, MRI grade, and bone type.

Main Results:

• 140 BSIs were analyzed in 83 athletes; average return-to-running was 47.8 days (men) and 64.8 days (women).
• Higher modified BSI scores significantly correlated with longer return-to-running times (8.5 days per risk point, P < .0001).
• MRI grade and CRA score were key predictors in men; bone location and type were key in women.

Conclusions:

• The modified BSI score shows a significant association with return-to-running times but has low to moderate predictive power.
• Integrating clinical data (CRA, location, type) moderately improved prediction in women but not men when added to MRI grade.
• Further research is required to ascertain if this modified BSI system surpasses MRI grade alone in predictive accuracy.