How Medial Tibial Stress Syndrome Is Affected by Alignment, Range of Motion, Strength, and Gait Biomechanics: A Systematic Review and Meta-Analysis.

Context: Medial tibial stress syndrome (MTSS) is a common chronic injury of the lower-extremity in the physically active population. However, the risk factors for MTSS remain unclear.

Objective: This study identified the risk factors for MTSS and established the continuum model of lower-extremity alignments, range of motion, muscular strength, and gait kinematics affecting each other and MTSS development.

Evidence acquisition: Online databases including PubMed, CINAHL, SPORTDiscus, and Web of Science were used to retrieve studies related to risk factors for MTSS. The study eligibility criteria were studies that used the MTSS definition of the Yates and White criteria, or included participants with MTSS, except for stress fracture and compartment syndrome. A total of 2099 papers were retrieved during the initial search stage. After screening, based on eligibility criteria and cross-reference, 21 papers were included in this study. Data on lower-extremity alignments, range of motion, muscular strength, and gait biomechanics were extracted as outcome variables for this meta-analysis. Publication bias was assessed using funnel plots and Egger's regression analysis.

Evidence synthesis: Foot posture index (standardized mean difference [SMD] = 1.23; 95% CI, 0.02-2.43), intercondylar interval (SMD = 0.29; 95% CI, 0.10-0.48), inversion range of motion (SMD = 0.37; 95% CI, 0.10-0.63), eversion strength (SMD = 0.37; 95% CI, 0.10-0.65), and dynamic arch height change during walking (SMD = 1.05; 95% CI, 0.49-1.60) were significant risk factors for MTSS. Egger's regression analysis revealed asymmetry in several variables, which indicates publication bias. The trim-and-fill method was applied to these variables. A comparison between the SMD and adjusted SMD showed that the variables had minimal impacts on the meta-analysis.

Conclusions: Based on our results, health care professionals should assess the significant risk factors in patients before participation in physical activities and treat them to prevent and rehabilitate MTSS.