Hoenig Tim, Hollander Karsten, Popp Kristin L, Fredericson Michael, Kraus Emily A, Warden Stuart J, Tenforde Adam S
Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany.
Br J Sports Med. 2025 Jan 2;59(2):78-90. doi: 10.1136/bjsports-2024-108616.
Bone stress injuries, commonly referred to as stress reactions and stress fractures, represent overuse injuries to bone. These injuries result in physical limitations in activity and can be career-ending for high-level athletes. While bone stress injuries have received increased attention in recent years, international consensus is lacking on definitions, risk factors and strategies for management and prevention. This study aimed to ascertain and improve the level of agreement on bone stress injuries by utilising a three-part modified Delphi approach on (1) pathophysiology, diagnosis, terminology and classification systems; (2) risk factors, screening and prevention; and (3) management and return to sport. A multidisciplinary steering committee initiated the consensus process. A panel of 41 members from six continents was formed to complete three rounds of voting, including experts (scientists and clinicians) and representatives (athletes and coaches). Thirty-three, 28 and 28 panel members completed Delphi rounds 1, 2 and 3, respectively. Consensus was reached on 41 out of 58 statements. Findings from this Delphi study outline a multifactorial approach to identify and manage bone stress injuries and to promote bone health in athletes. This includes recommendations for diagnostic workup and treatment to assist clinicians in caring for patients with bone stress injuries. Finally, this consensus process identifies knowledge gaps and provides a framework for future research to advance the clinical care and prevention of bone stress injuries.
骨应力损伤，通常称为应力反应和应力性骨折，是指骨骼的过度使用损伤。这些损伤会导致活动受限，对于高水平运动员来说可能会终结其职业生涯。尽管近年来骨应力损伤受到了越来越多的关注，但在定义、风险因素以及管理和预防策略方面仍缺乏国际共识。本研究旨在通过对以下三个方面采用三部分改良德尔菲法来确定并提高对骨应力损伤的共识水平：（1）病理生理学、诊断、术语和分类系统；（2）风险因素、筛查和预防；（3）管理和恢复运动。一个多学科指导委员会启动了共识达成过程。成立了一个由来自六大洲的41名成员组成的小组，以完成三轮投票，其中包括专家（科学家和临床医生）以及代表（运动员和教练）。分别有33名、28名和28名小组成员完成了德尔菲法的第1轮、第2轮和第3轮投票。在58条陈述中有41条达成了共识。这项德尔菲研究的结果概述了一种多因素方法，用于识别和管理骨应力损伤以及促进运动员的骨骼健康。这包括对诊断检查和治疗的建议，以协助临床医生护理骨应力损伤患者。最后，这一共识达成过程确定了知识空白，并为未来的研究提供了一个框架，以推进骨应力损伤的临床护理和预防工作。
