Casusbespreking: diagnose, opvolging en return to sport bij endomedullair oedeem van de femurdiafyse

Case report: diagnosis, follow-up and return to sport in endomedullar edema of the femur diaphysis Bone stress injuries are frequent overuse injuries that are typically more common in female athletes and are characterized by a high recurrence rate. They involve a continuum, ranging from periosteal and/or endomedullar edema to the presence of a stress fracture with sometimes extension to a complete fracture. In (female) athletes, the term “Relative Energy Deficiency in Sports (RED-S)” deserves extra attention. This is an updated and expanded term for the condition formerly known as “female athlete triad. RED-S syndrome results from relative energy deficiency that affects many physiological functions, including metabolism, menstrual cycle, bone density, immunity, protein synthesis, cardiovascular and psychological health (1). Early recognition of bone stress injuries is important in the prevention of recurrences and allows adequate early management. This case report presents the diagnosis, follow-up and return to sport of an overuse stress injury in a 23-year-old female soccer player at the highest level in Belgium. It concerns a low-risk endomedullar edema of the femur in which a two-stage policy was used in the return to sport. After an initial period of relative rest and non-weight bearing strength and conditioning training, an incremental running schedule was followed. The patient completed part of this schedule in the AlterG to obtain weight relief. A weekly follow-up was provided during which the VAS-score was questioned and fulcrum testing was performed. Three weeks after the initial MRI, resolution of the endomedullar edema on the control MRI was seen. The patient was able to gradually resume training after about three months. Right before the return to play, a second control MRI was performed, which confirmed permanent resolution of the endomedullar edema.