Winters M, et al. - In order to assess if the occurrence of microdamage and its possible link with targeted remodeling could assist in assessing the development of medial tibial stress syndrome (MTSS), researchers retrospectively evaluated biopsies (taken earlier from the painful area in athletes with MTSS) for the presence of linear microcracks, diffuse microdamage and remodeling. They evaluated a total of six biopsies for the occurrence of microdamage and remodeling. Biopsies taken from the painful area in 50% of the athletes with MTSS showed only linear microcracks in vivo, which was consistent with the relationship between linear cracks and fatigue-associated overloading of bone. A repair reaction was absent almost universally. Unrepaired microdamage accumulation seemed to lie beneath the pathophysiological basis for MTSS in athletes.