Bennell1996models

Models for the pathogenesis of stress fractures in athletes

Bennell, Malcolm, Wark, and Brukner 1996

Solid review. A lot of references to check out later.

Bone notes

  • Frost’s threshold for microdamage threshold: 2k microstrains (upper range of physiological values) citation #40
  • lower bone density as a risk: citations 25 26 32 33
  • limitation of crack propogation (geometry): citation 54
  • targeted bone repair: citatiosn 22 33 42 46 47 50 52 54

Role of Muscle

  • may depend on the location of the fracture:
  • muscle causes increased bone strain at attachment sites: citation 66 67
  • muscles attenuate forces: citation 68, 69, 70
  • bigger calf muscles protect the tibia: 72 (military), 73 (female athletes)

Model for pathogenesis

2 models, not necessarily exclusive: Microdamage then targeted remodeling OR remodeling naturally occurs, weakens bone pre-osteoblast activity, and microdamage occurs in this location. Either way, if microdamage rates > repair, stress fracture occurs:

Notable References

  1. Frost 1989 Transient-steady state phenomena in microdamage physiology: a proposed algorithm for lamellar bone
  2. Frost 1991: Some ABC’s of skeletal pathophysiology 5. microdamage physiology ribs with microdamage:
  3. Rutishauser & Majno: physiopathology of bone tissue: the osteocytes and fundebental substance
  4. Frost 1960 Presence of microscopic cracks in vivo in bone

damage accumulation with repetitive loading: rabbits:

  1. #48
  2. #49