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. 2004 Feb;38(1):15–18. doi: 10.1136/bjsm.2002.000695

99mTc-MDP bone SPECT in evaluation of the knee in asymptomatic soccer players

M Yildirim 1, R Gursoy 1, E Varoglu 1, Y Oztasyonar 1, S Cogalgil 1
PMCID: PMC1724727  PMID: 14751939

Abstract

Objective: To evaluate stress fractures in leg (particularly around the knee, tibia, and femur) and knee pathology in active asymptomatic (no symptoms in the preceding month) soccer players.

Method: The study included 42 asymptomatic soccer players (21 women, 21 men; age range 19–31 years). Players from seven teams in the major female professional and amateur male soccer leagues were examined by technetium-99m-methylene diphosphonate (99mTc-MDP) bone scintigraphy during the soccer season. Four hours after intravenous injection of 20 mCi 99mTc-MDP, standard imaging included anterior planar spot images of the legs, lateral images of the knee, and single photon emission computed tomography (SPECT).

Results: Although the players were asymptomatic, increased tracer uptake, indicating stress fracture, was found in 28 (66%). Most of the stress fractures were in the tibia (62%) and femur (5%). In the 42 subjects (84 legs), 35 sites (42%) showed rupture of the posterior horn of the lateral meniscus and bone bruising of the tibial plateau, 16 sites (19%) showed rupture of the anterior horn of the medial meniscus, 11 sites (13%) showed bone bruising of the lateral femoral condyle, eight sites (10%) showed bone bruising of the medial femoral condyle, and there was avulsion injury to the infrapatellar tendon insertion in the anterior tibia in 34 sites (40%). There were 11 anterior cruciate ligament injuries.

Conclusion: Bone SPECT is very accurate, easy to perform, cost effective, may give valuable information before magnetic resonance imaging studies in the detection of meniscal tears, and may be used successfully when magnetic resonance imaging is unavailable.

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Selected References

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  1. Anderson M. W., Greenspan A. Stress fractures. Radiology. 1996 Apr;199(1):1–12. doi: 10.1148/radiology.199.1.8633129. [DOI] [PubMed] [Google Scholar]
  2. Bjordal J. M., Arnły F., Hannestad B., Strand T. Epidemiology of anterior cruciate ligament injuries in soccer. Am J Sports Med. 1997 May-Jun;25(3):341–345. doi: 10.1177/036354659702500312. [DOI] [PubMed] [Google Scholar]
  3. Boden B. P., Osbahr D. C., Jimenez C. Low-risk stress fractures. Am J Sports Med. 2001 Jan-Feb;29(1):100–111. doi: 10.1177/03635465010290010201. [DOI] [PubMed] [Google Scholar]
  4. Brukner P., Bradshaw C., Khan K. M., White S., Crossley K. Stress fractures: a review of 180 cases. Clin J Sport Med. 1996 Apr;6(2):85–89. [PubMed] [Google Scholar]
  5. Brukner P., Fanton G., Bergman A. G., Beaulieu C., Matheson G. O. Bilateral stress fractures of the anterior part of the tibial cortex. A case report. J Bone Joint Surg Am. 2000 Feb;82(2):213–218. doi: 10.2106/00004623-200002000-00007. [DOI] [PubMed] [Google Scholar]
  6. Collier B. D., Johnson R. P., Carrera G. F., Isitman A. T., Veluvolu P., Knobel J., Hellman R. S., Barthelemy C. R. Chronic knee pain assessed by SPECT: comparison with other modalities. Radiology. 1985 Dec;157(3):795–802. doi: 10.1148/radiology.157.3.3877315. [DOI] [PubMed] [Google Scholar]
  7. Cook G. J., Ryan P. J., Clarke S. E., Fogelman I. SPECT bone scintigraphy of anterior cruciate ligament injury. J Nucl Med. 1996 Aug;37(8):1353–1356. [PubMed] [Google Scholar]
  8. Dhuper S., Warren M. P., Brooks-Gunn J., Fox R. Effects of hormonal status on bone density in adolescent girls. J Clin Endocrinol Metab. 1990 Nov;71(5):1083–1088. doi: 10.1210/jcem-71-5-1083. [DOI] [PubMed] [Google Scholar]
  9. Drinkwater B. L., Nilson K., Chesnut C. H., 3rd, Bremner W. J., Shainholtz S., Southworth M. B. Bone mineral content of amenorrheic and eumenorrheic athletes. N Engl J Med. 1984 Aug 2;311(5):277–281. doi: 10.1056/NEJM198408023110501. [DOI] [PubMed] [Google Scholar]
  10. Dvorak J., Junge A. Football injuries and physical symptoms. A review of the literature. Am J Sports Med. 2000;28(5 Suppl):S3–S9. doi: 10.1177/28.suppl_5.s-3. [DOI] [PubMed] [Google Scholar]
  11. Gwinn D. E., Wilckens J. H., McDevitt E. R., Ross G., Kao T. C. The relative incidence of anterior cruciate ligament injury in men and women at the United States Naval Academy. Am J Sports Med. 2000 Jan-Feb;28(1):98–102. doi: 10.1177/03635465000280012901. [DOI] [PubMed] [Google Scholar]
  12. Highet R. Athletic amenorrhoea. An update on aetiology, complications and management. Sports Med. 1989 Feb;7(2):82–108. doi: 10.2165/00007256-198907020-00002. [DOI] [PubMed] [Google Scholar]
  13. Myburgh K. H., Hutchins J., Fataar A. B., Hough S. F., Noakes T. D. Low bone density is an etiologic factor for stress fractures in athletes. Ann Intern Med. 1990 Nov 15;113(10):754–759. doi: 10.7326/0003-4819-113-10-754. [DOI] [PubMed] [Google Scholar]
  14. Ryan P. J. Bone SPECT of the knees. Nucl Med Commun. 2000 Oct;21(10):877–885. doi: 10.1097/00006231-200010000-00001. [DOI] [PubMed] [Google Scholar]
  15. Ryan P. J., Reddy K., Fleetcroft J. A prospective comparison of clinical examination, MRI, bone SPECT, and arthroscopy to detect meniscal tears. Clin Nucl Med. 1998 Dec;23(12):803–806. doi: 10.1097/00003072-199812000-00002. [DOI] [PubMed] [Google Scholar]
  16. Tucker A. M. Common soccer injuries. Diagnosis, treatment and rehabilitation. Sports Med. 1997 Jan;23(1):21–32. doi: 10.2165/00007256-199723010-00003. [DOI] [PubMed] [Google Scholar]
  17. Warren M. P., Brooks-Gunn J., Fox R. P., Lancelot C., Newman D., Hamilton W. G. Lack of bone accretion and amenorrhea: evidence for a relative osteopenia in weight-bearing bones. J Clin Endocrinol Metab. 1991 Apr;72(4):847–853. doi: 10.1210/jcem-72-4-847. [DOI] [PubMed] [Google Scholar]
  18. Warren M. P., Perlroth N. E. The effects of intense exercise on the female reproductive system. J Endocrinol. 2001 Jul;170(1):3–11. doi: 10.1677/joe.0.1700003. [DOI] [PubMed] [Google Scholar]
  19. Zwas S. T., Elkanovitch R., Frank G. Interpretation and classification of bone scintigraphic findings in stress fractures. J Nucl Med. 1987 Apr;28(4):452–457. [PubMed] [Google Scholar]

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