Beware with the clinical diagnosis of pes anserine tendinitis in recreational runners: it may be a stress fracture in the medial tibial plateau. Report of two cases

Abstract

Abstract
Introduction: Diagnosis of stress fracture in the medial tibial plateau can be confused with other different diagnoses,
precisely because the site of pain and tenderness is very similar to meniscal injuries and pes anserine tendinitis, which
are common injuries in runner patients. Objective: Report two cases that were initially interpreted as pes anserine
tendinitis in the initial evaluation, and later were diagnosed as bilateral stress fracture in the medial tibial plateau.
Case Report: Two female patients, 31 and 32 years old respectively, started the practice of street running, without
supervision, and six and eight weeks after the beginning of the practice, they evolved with knee pain, bilaterally,
on the medial face. In the initial evaluation, the condition  was interpreted as pes anserine tendonitis. As they had no
improvement, they sought new medical care, in which the diagnosis of a stress fracture in the medial tibial plateau
was suspected, and bilateral magnetic resonance examinations were requested, which confirmed the diagnosis. Both
patients were treated conservatively, with restriction to impact activities for 6 weeks, load according to pain, simple
analgesia with dipyrone, ice, and sodium ibandronate for 2 months. The patients returned after 6 weeks with clinical
improvement. After physiotherapy sessions, they were successfully released for impact activities. Conclusion: These
cases emphasize the importance of the suspicion of stress fracture in the medial tibial plateau in recreational runners
with pain in the medial side of the knee, especially if there has been a change in their pattern or intensity of running.
Keywords: Knee, Stress fracture, Tibial fracture