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Pacífico Júnior GM, Sauma ML, Costa LAV, Taniguchi LFP, Blumetti FC. Avulsion Fracture of the Tibial Tuberosity in an Adolescent: Case Report. Rev Bras Ortop 2023; 58:e808-e812. [PMID: 37908530 PMCID: PMC10615600 DOI: 10.1055/s-0040-1722596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/16/2020] [Indexed: 10/21/2022] Open
Abstract
The present study reports a rare case of avulsion fracture of the tibial tuberosity in an adolescent. A 14-year-old male patient sprained his left knee during a soccer match. At the first emergency-room visit, he presented pain in his left knee, 2 +/4+ edema, and inability to walk and flex the affected knee, but no neurovascular changes or signs of compartment syndrome. Radiographs revealed a physeal fracture at the left proximal tibia, classified by Ogden, Tross and Murphy, and modified by Ryu and Debenham, as type IV, and complemented by Aerts et al. as type IV-B. Immobilization was performed with a plaster cast from the inguinal to malleolar regions, followed by analgesia. The patient was operated on the next day, when open reduction and internal fixation using 4.5-mm cannulated screws were performed. The patient was discharged one day after surgery, with plaster cast immobilization and load restraint for four weeks, and bone consolidation was radiologically confirmed three months after the procedure. The patient evolved with a range of motion similar to that of the contralateral limb, no length discrepancy in the lower limbs, and no complaints after one year of follow-up.
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Affiliation(s)
| | - Marcel Lobato Sauma
- Departamento de Ortopedia e Traumatologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | | | | | - Francesco Camara Blumetti
- Departamento de Ortopedia e Traumatologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
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2
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Kraus E, Rizzone K, Walker M, Brown N, Kaur J, Magrini D, Glover J, Nussbaum E. Stress Injuries of the Knee. Clin Sports Med 2022; 41:707-727. [DOI: 10.1016/j.csm.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Caine D, Maffulli N, Meyers R, Schöffl V, Nguyen J. Inconsistencies and Imprecision in the Nomenclature Used to Describe Primary Periphyseal Stress Injuries: Towards a Better Understanding. Sports Med 2022; 52:685-707. [PMID: 35247201 DOI: 10.1007/s40279-022-01648-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 11/26/2022]
Abstract
Stress injuries involving the epiphyseal-physeal-metaphyseal complex affecting the extremities of child and adolescent athletes were first described in the early 1950s. Initially observed in Little League baseball players, these injuries are now known to affect skeletally immature athletes in a variety of sports that involve high-impact repetitive overuse activities. Collectively known as primary periphyseal stress injuries, they may affect the long bones around the shoulder, elbow, wrist, hand, hip, knee, ankle, and foot of young athletes. These injuries respond well to timely treatment and relative rest, while non-compliance with non-operative treatment can produce skeletal growth disruption and resultant limb deformity. A major concern raised from the existing literature on primary periphyseal stress injuries is the long history of inconsistent and imprecise terminology used to describe these injuries. A variety of terms have been used to describe primary periphyseal stress injuries, including those which potentially misinform regarding who may be affected by these injuries and the true nature and pathophysiologic mechanisms involved. These imprecisions and inconsistencies arise, at least in part, from a misunderstanding or incomplete understanding of the nature and mechanism of primary periphyseal stress injuries. In this article, we examine the inconsistent and imprecise nomenclature historically used to describe primary periphyseal stress injuries. We also offer a novel framework for understanding the pathophysiologic mechanisms behind these injuries, and provide suggestions for more standard use of terminology and further research moving forward.
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Affiliation(s)
- Dennis Caine
- Kinesiology and Public Health Education, Division of Education, Health and Behavior Studies, University of North Dakota, Hyslop Sport Center, 2721 2nd Ave N Stop 8235, Grand Forks, ND, 58202-8235, USA.
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Via Salvador Allende, 43, Baronissi SA, 84081, Salerno, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Largo Città di Ippocrate, 84131, Salerno, Italy
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London, E14DG, England
- School of Pharmacy and Bioengineering, Faculty of Medicine, Guy Hilton Research Centre, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, England, UK
| | - Rachel Meyers
- Department of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnatti, OH, 45229, USA
| | - Volker Schöffl
- Klinik Für Orthopädie Und Unfallchirurgie, Sozialstiftung Bamberg, Buger Straße 80, 96049, Bamberg, Germany
- Klinik für Unfallchirurgie und Orthopädische Chirurgie, Freidrich Alexander Universität Erlangen-Nürnberg, FRG, Erlangen, Germany
- School of Clinical and Applied Sciences, Leeds Becket University, Leeds, UK
- Section of Wilderness Medicine, Department of Emergency Medicine, School of Medicine, University of Colorado, Denver, USA
| | - Jie Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Primary Periphyseal Stress Injuries in Young Athletes: A Systematic Review. Sports Med 2021; 52:741-772. [PMID: 34370212 DOI: 10.1007/s40279-021-01511-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Overuse injuries are common in sporting children and adolescents. These injuries are a particular concern when they involve the epiphyseal-physeal-metaphyseal (EPM) complex given their potential to disturb skeletal growth. Specifically, the limits of mechanical tolerance of the EPM complex to repetitive stress may be exceeded by the intense and continuous training characteristic of many youth sports today. OBJECTIVE This article describes the present status of knowledge on the occurrence and outcome of primary periphyseal stress injuries (PPSIs) affecting the EPM complex in the extremities of children and adolescents involved in youth sports. METHODS A comprehensive review of the sports medicine literature was conducted to determine the nature and extent of PPSIs affecting the EPM complex of the extremities among youth sports participants and the potential for consequent skeletal growth disturbance and resultant limb deformity associated with these injuries. RESULTS Our initial search uncovered 128 original published scientific articles reporting relevant data on PPSIs. There were 101 case reports/series, 19 cross-sectional, 1 case-control, and 7 cohort studies with relevant data. The case reports/series studies reported 448 patients with PPSIs involving the extremities. Children and adolescents representing a variety of high impact repetitive youth sports activities-including baseball, badminton, climbing, cricket, dance, gymnastics, rugby, soccer, swimming, tennis, and volleyball-may sustain PPSIs involving the shoulder, elbow, hand and wrist, knee, and ankle and foot. Although incidence data from prospective cohort studies are lacking, data arising from cross-sectional studies suggest that PPSIs may be common in select groups of youth athletes-including the shoulder in baseball players (0-36.6%), wrist in gymnasts (10-83%) and platform divers (52.6%), and fingers in rock climbers (5-58%). Notably, not all stress-related skeletal changes detected on imaging were symptomatic in these studies. When diagnosed and treated with an appropriate period of rest and rehabilitation, most patients studied were able to return to their sport activities. However, our data also show that 57/448 PPSIs (12.7%) produced growth disturbance, and that 28/448 patients (6.2%) underwent surgery for their injuries. Absence of treatment, delayed presentation and diagnosis, and non-compliance with a rest regimen were common in cases that produced growth disturbance. CONCLUSIONS PPSIs may affect the extremities of children and adolescents engaged in a variety of youth sports, especially at advanced levels of training and competition. Most skeletally immature patients with PPSIs respond well to timely treatment; however, in extreme cases, PPSIs can progress to produce skeletal growth disruption which may necessitate surgical intervention. Clearly, establishing the early diagnosis of PPSIs and providing timely treatment of these injuries are needed to ensure the skeletal health of youth sports participants. Rigorous prospective longitudinal epidemiological and imaging studies designed to provide incidence rates of PPSIs and to determine the effect of PPSIs on long-term skeletal health are also necessary.
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Bianco A, Ravalli S, Maugeri G, D’Agata V, Vecchio M, D’Amico AG, Pavone V, Lucenti L, Amato A, Gentile A, Giustino V, Feka K, Thomas E, Musumeci G. The " Journal of Functional Morphology and Kinesiology" Journal Club Series: Highlights on Recent Papers in Overtraining and Exercise Addiction. J Funct Morphol Kinesiol 2019; 4:E68. [PMID: 33467383 PMCID: PMC7739227 DOI: 10.3390/jfmk4040068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 02/07/2023] Open
Abstract
We are glad to introduce the seventeenth Journal Club. This edition is focused on several relevant studies published in the last years in the field of Overtraining and Exercise Addiction, chosen by our Editorial Board members and their colleagues. We hope to stimulate your curiosity in this field and to share with you the passion for the sport seen also from the scientific point of view. The Editorial Board members wish you an inspiring lecture.
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Affiliation(s)
- Antonino Bianco
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli 6, 90144 Palermo, Italy; (A.B.); (A.A.); (A.G.); (V.G.); (K.F.); (E.T.)
| | - Silvia Ravalli
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Via S. Sofia 87, 95123 Catania, Italy; (S.R.); (G.M.); (V.D.)
| | - Grazia Maugeri
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Via S. Sofia 87, 95123 Catania, Italy; (S.R.); (G.M.); (V.D.)
| | - Velia D’Agata
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Via S. Sofia 87, 95123 Catania, Italy; (S.R.); (G.M.); (V.D.)
| | - Michele Vecchio
- Department of Biomedical and Biotechnological Sciences, University of Catania–U.O. Rehabilitation A.O.U. “Policlinico-Vittorio Emanuele”, 95123 Catania, Italy;
| | - Agata Grazia D’Amico
- San Raffaele Open University of Rome, Department of Human Science and Promotion of quality of Life, 00148 Rome, Italy;
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (V.P.); (L.L.)
| | - Ludovico Lucenti
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (V.P.); (L.L.)
| | - Alessandra Amato
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli 6, 90144 Palermo, Italy; (A.B.); (A.A.); (A.G.); (V.G.); (K.F.); (E.T.)
| | - Ambra Gentile
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli 6, 90144 Palermo, Italy; (A.B.); (A.A.); (A.G.); (V.G.); (K.F.); (E.T.)
| | - Valerio Giustino
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli 6, 90144 Palermo, Italy; (A.B.); (A.A.); (A.G.); (V.G.); (K.F.); (E.T.)
| | - Kaltrina Feka
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli 6, 90144 Palermo, Italy; (A.B.); (A.A.); (A.G.); (V.G.); (K.F.); (E.T.)
| | - Ewan Thomas
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli 6, 90144 Palermo, Italy; (A.B.); (A.A.); (A.G.); (V.G.); (K.F.); (E.T.)
| | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Via S. Sofia 87, 95123 Catania, Italy; (S.R.); (G.M.); (V.D.)
- Research Center on Motor Activities (CRAM), University of Catania, 95123 Catania, Italy
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Tirosh O, Orland G, Eliakim A, Nemet D, Steinberg N. Tibial impact accelerations in gait of primary school children: The effect of age and speed. Gait Posture 2017; 57:265-269. [PMID: 28683418 DOI: 10.1016/j.gaitpost.2017.06.270] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 06/07/2017] [Accepted: 06/26/2017] [Indexed: 02/02/2023]
Abstract
Tibial stress fractures are associated with increased lower extremity loading at initial foot-ground contact, reflected in high peak positive acceleration (>8g) of the tibia in adults. There is no reported data on peak positive acceleration of the tibia in children during walking and running. The aim of this study was to establish tibial peak positive acceleration responses in children across a range of age and gait speeds. Twenty-four children aged 8.5±1.4years with no known gait pathology comprised two age groups; Young (7-9year, n=12) and Older (10-12 years, n=12). Wireless Inertial Measurement Unit comprising a tri-axial accelerometer was securely taped to the anteromedial aspect of the distal tibia to measure peak positive acceleration responses while walking and running on the treadmill at 3 different speeds (20% below baseline, baseline, and 20% above baseline). Results showed significant increase in peak positive acceleration with increased gait speed and greater variability in young children compared to older children. The study suggests that ground impact in walking, but not running, is mature by age 7 years. Future studies should explore strategies using peak positive acceleration responses to monitor ground impact during sport activities and its application in gait retraining.
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Affiliation(s)
- Oren Tirosh
- School of Health Sciences, Swinburne University of Technology, 6 Luton Lane, Hawthorn, Victoria, 3122, Australia.
| | - Guy Orland
- The Wingate College of Physical Education and Sports Sciences at the Wingate Institute, Israel
| | - Alon Eliakim
- Child Health and Sport center, Pediatric Department, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - Dan Nemet
- Child Health and Sport center, Pediatric Department, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - Nili Steinberg
- The Wingate College of Physical Education and Sports Sciences at the Wingate Institute, Israel
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Arnold A, Thigpen CA, Beattie PF, Kissenberth MJ, Shanley E. Overuse Physeal Injuries in Youth Athletes. Sports Health 2017; 9:139-147. [PMID: 28165873 PMCID: PMC5349397 DOI: 10.1177/1941738117690847] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Context: Despite rising awareness of the risks associated with sports participation, overuse injuries continue to increase in youth athlete populations. Physeal injuries are one type of overuse injury exclusive to pediatric populations that are often sustained during athletic practice or competition. Overuse physeal injuries are, in theory, preventable; however, little consensus has been reached surrounding the risk factors, prevention, and treatment strategies. Objective: This systematic review summarizes the best available evidence concerning overuse physeal injuries in youth and adolescent athletes. It can be used to develop prevention and treatment programs specific to this population. Data Sources: PubMed and Academic Search Complete (EBSCOhost) were explored using the keyword physeal injuries from January 1950 through May 2015 to identify 24 studies. Study Selection: Original research studies of athletic populations with mechanisms of injury related to sport were chosen. Study Design: Systematic review. Level of Evidence: Level 3. Data Extraction: Data were extracted as available from 24 eligible studies. Study quality was rated using the Oxford Centre for Evidence-based Medicine (OCEBM) guidelines. Results: Risk factors for injury include periods of accelerated growth, chronological age, body size, training volume, and previous injury. Injury prevention strategies currently emphasize participation limitations and sport-specific training programs in skeletally immature athletes. The most effective treatment after an overuse physeal injury was an extended period of active rest and joint immobilization when necessary. Conclusion: Overuse physeal injuries are multifactorial in nature. Muscular imbalances after accelerated growth periods predispose young athletes to overuse injuries. Modifiable risk factors such as flexibility, strength, and training volume should be regularly monitored to prevent these injuries.
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Affiliation(s)
- Amanda Arnold
- University of South Carolina, Greenville, South Carolina
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The Exceptionality of the Young Athlete. CONTEMPORARY PEDIATRIC AND ADOLESCENT SPORTS MEDICINE 2016. [DOI: 10.1007/978-3-319-18141-7_1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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9
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Quantitative Evaluation of Growth Plates around the Knees of Adolescent Soccer Players by Diffusion-Weighted Magnetic Resonance Imaging. BIOMED RESEARCH INTERNATIONAL 2015; 2015:482017. [PMID: 26693482 PMCID: PMC4674579 DOI: 10.1155/2015/482017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/25/2015] [Accepted: 11/09/2015] [Indexed: 12/28/2022]
Abstract
Purpose. To quantitatively evaluate growth plates around the knees in adolescent soccer players utilizing the diffusion-weighted MR imaging (DWI). Methods. The knees and adjacent growth plates of eleven 14-year-old male soccer players were evaluated by MRI before (end of season's summer break) and after two months of intense soccer training. MRI evaluation was conducted in coronal plane by PD-FSE and DWI. All images were screened for any major pathological changes. Later, central growth plate surface area (CGPSA) was measured and the apparent diffusion coefficient (ADC) values were calculated in two most central coronal slices divided into four regions: distal femur medial (DFM), distal femur lateral (DFL), proximal tibia medial (PTM), and proximal tibia lateral (PTL). Results. No gross pathology was diagnosed on MRI. CGPSA was not significantly reduced: DFM 278 versus 272, DFL 265 versus 261, PTM 193 versus 192, and PTL 214 versus 210. ADC decrease was statistically significant only for PTM: DFM 1.27 versus 1.22, DFL 1.37 versus 1.34, PTM 1.13 versus 1.03 (p = 0.003), and PTL 1.28 versus 1.22. Conclusions. DWI measurements indicate increased cellularity in growth plates around knees in footballers most prominent in PTM after intense training. No detectable differences on a standard PD-FSE sequence were observed.
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10
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Aerts BRJ, Ten Brinke B, Jakma TSC, Punt BJ. Classification of proximal tibial epiphysis fractures in children: Four clinical cases. Injury 2015; 46:1680-3. [PMID: 26100208 DOI: 10.1016/j.injury.2015.05.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 05/14/2015] [Indexed: 02/02/2023]
Affiliation(s)
- B R J Aerts
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
| | - B Ten Brinke
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - T S C Jakma
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - B J Punt
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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11
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Tony G, Charran A, Tins B, Lalam R, Tyrrell PNM, Singh J, Cool P, Kiely N, Cassar-Pullicino VN. Intra-epiphyseal stress injury of the proximal tibial epiphysis: preliminary experience of magnetic resonance imaging findings. Eur J Radiol 2014; 83:2051-7. [PMID: 25183557 DOI: 10.1016/j.ejrad.2014.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/31/2014] [Accepted: 08/08/2014] [Indexed: 10/24/2022]
Abstract
Stress induced injuries affecting the physeal plate or cortical bone in children and adolescents, especially young athletes, have been well described. However, there are no reports in the current English language literature of stress injury affecting the incompletely ossified epiphyseal cartilage. We present four cases of stress related change to the proximal tibial epiphysis (PTE) along with their respective magnetic resonance imaging (MRI) appearances ranging from subtle oedema signal to a pseudo-tumour like appearance within the epiphyseal cartilage. The site and pattern of intra-epiphyseal injury is determined by the type of tissue that is affected, the maturity of the skeleton and the type of forces that are transmitted through the tissue. We demonstrate how an awareness of the morphological spectrum of MRI appearances in intra-epiphyseal stress injury and the ability to identify concomitant signs of stress in other nearby structures can help reduce misdiagnosis, avoid invasive diagnostic procedures like bone biopsy and reassure patients and their families.
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Affiliation(s)
- G Tony
- Stafford General Hospital, Weston Road, Stafford, Staffordshire ST16 3SA, UK.
| | - A Charran
- Hillingdon Hospital, Pield Heath Rd, Uxbridge, Middlesex UB8 3NN, UK.
| | - B Tins
- Department of Diagnostic Imaging, Robert Jones and Agnes Hunt, Orthopaedic Hospital, Oswestry, Shropshire SY10 7 AG, UK.
| | - R Lalam
- Department of Diagnostic Imaging, Robert Jones and Agnes Hunt, Orthopaedic Hospital, Oswestry, Shropshire SY10 7 AG, UK.
| | - P N M Tyrrell
- Department of Diagnostic Imaging, Robert Jones and Agnes Hunt, Orthopaedic Hospital, Oswestry, Shropshire SY10 7 AG, UK.
| | - J Singh
- Department of Diagnostic Imaging, Robert Jones and Agnes Hunt, Orthopaedic Hospital, Oswestry, Shropshire SY10 7 AG, UK.
| | - P Cool
- Orthopaedic Oncology, Robert Jones and Agnes Hunt, Orthopaedic Hospital, Oswestry, Shropshire SY10 7 AG, UK.
| | - N Kiely
- Paediatric Orthopaedics, Robert Jones and Agnes Hunt, Orthopaedic Hospital, Oswestry, Shropshire SY10 7 AG, UK.
| | - V N Cassar-Pullicino
- Department of Diagnostic Imaging, Robert Jones and Agnes Hunt, Orthopaedic Hospital, Oswestry, Shropshire SY10 7 AG, UK.
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12
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Caine D, Purcell L, Maffulli N. The child and adolescent athlete: a review of three potentially serious injuries. BMC Sports Sci Med Rehabil 2014; 6:22. [PMID: 24926412 PMCID: PMC4055241 DOI: 10.1186/2052-1847-6-22] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 05/23/2014] [Indexed: 01/13/2023]
Abstract
The increased participation of children and adolescents in organized sports worldwide is a welcome trend given evidence of lower physical fitness and increased prevalence of overweight in this population. However, the increased sports activity of children from an early age and continued through the years of growth, against a background of their unique vulnerability to injury, gives rise to concern about the risk and severity of injury. Three types of injury–anterior cruciate ligament (ACL) injury, concussion, and physeal injury – are considered potentially serious given their frequency, potential for adverse long-term health outcomes, and escalating healthcare costs. Concussion is probably the hottest topic in sports injury currently with voracious media coverage and exploding research interest. Given the negative cognitive effects of concussion, it has the potential to have a great impact on children and adolescents during their formative years and potentially impair school achievement and, if concussion management is not managed appropriately, there can be long term negative impact on cognitive development and ability to resume sports participation. Sudden and gradual onset physeal injury is a unique injury to the pediatric population which can adversely affect growth if not managed correctly. Although data are lacking, the frequency of stress-related physeal injury appears to be increasing. If mismanaged, physeal injuries can also lead to long-term complications which could negatively affect ability to participate in sports. Management of ACL injuries is an area of controversy and if not managed appropriately, can affect long-term growth and recovery as well as the ability to participate in sports. This article considers the young athlete’s vulnerability to injury, with special reference to ACL injury, concussion, and physeal injury, and reviews current research on epidemiology, diagnosis, treatment, and prevention of these injury types. This article is intended as an overview of these injury types for medical students, healthcare professionals and researchers.
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Affiliation(s)
- Dennis Caine
- Department of Kinesiology and Public Health Education, University of North Dakota, Grand Forks, ND, USA
| | - Laura Purcell
- Department of Pediatrics, David Braley Sport Medicine and Rehabilitation Centre, McMaster University, Hamilton, ON, Canada
| | - Nicola Maffulli
- Sports and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, William Harvey Research Institute, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK
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13
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Bernholt DL, Garzon-Muvdi J, Chhabra A, McFarland EG. Stress fracture of the distal tibial physis in an adolescent recreational dancer. Am J Sports Med 2013; 41:1649-52. [PMID: 23605222 DOI: 10.1177/0363546513485938] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- David L Bernholt
- Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, Baltimore, MD 21224-2780, USA
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14
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Siebenrock KA, Behning A, Mamisch TC, Schwab JM. Growth plate alteration precedes cam-type deformity in elite basketball players. Clin Orthop Relat Res 2013; 471:1084-91. [PMID: 23247816 PMCID: PMC3585998 DOI: 10.1007/s11999-012-2740-6] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 12/03/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Vigorous sporting activity during the growth years is associated with an increased risk of having a cam-type deformity develop. The underlying cause of this osseous deformity is unclear. One may speculate whether this is caused by reactive bone apposition in the region of the anterosuperior head-neck junction or whether sports activity alters the shape of and growth in the growth plate. If the latter is true, then one would expect athletes to show an abnormal shape of the capital growth plate (specifically, the epiphyseal extension) before and/or after physeal closure. QUESTIONS/PURPOSES We therefore raised three questions: (1) Do adolescent basketball players show abnormal epiphyseal extension? (2) Does the epiphyseal extension differ before and after physeal closure? (3) Is abnormal epiphyseal extension associated with high alpha angles? METHODS We performed a case-control comparative analysis of young (age range, 9-22 years) male elite basketball athletes with age-matched nonathletes, substratified by whether they had open or closed physes. We measured epiphyseal extension on radial-sequence MRI cuts throughout the cranial hemisphere from 9 o'clock (posterior) to 3 o'clock (anterior). Epiphyseal extension was correlated to alpha angle measurements at the same points. RESULTS Epiphyseal extension was increased in all positions in the athletes compared with the control group. On average, athletes showed epiphyseal extension of 0.67 to 0.83 versus 0.53 to 0.71 in control subjects. In the control group epiphyseal extension was increased at all measurement points in hips after physeal closure compared with before physeal closure. In contrast, the subgroup of athletes with a closed growth plate only had increased epiphyseal extension at the 3 o'clock position compared with the athletes with an open [corrected] growth plate (0.64-0.70). We observed a correlation between an alpha angle greater than 55° and greater epiphyseal extension in the anterosuperior femoral head quadrant: the corresponding Spearman r values were 0.387 (all hips) and 0.285 (alpha angle>55°) for the aggregate anterosuperior quadrant. CONCLUSIONS These findings suggest that a cam-type abnormality in athletes is a consequence of an alteration of the growth plate rather than reactive bone formation. High-level sports activity during growth may be a new and distinct risk factor for a cam-type deformity.
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Affiliation(s)
- Klaus A Siebenrock
- Department of Orthopaedic Surgery, University of Bern, Inselspital, Freiburgstrasse, 3010, Bern, Switzerland.
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Yanaguizawa M, Taberner GS, Aihara AY, Yamaguchi CK, Guimarães MC, Rosenfeld A, Fernandes JL, Fernandes ADRC. Avaliação por imagem das lesões da placa de crescimento. Radiol Bras 2008. [DOI: 10.1590/s0100-39842008000300013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
As estruturas responsáveis pelo crescimento do osso incluem a fise (também chamada placa de crescimento) e as epífises. Afecções que acometem pacientes com o esqueleto imaturo, ou seja, com a placa de crescimento ainda aberta, podem interferir no crescimento ósseo, resultando em complicações como parada do crescimento, encurtamento dos membros ou deformidades angulares. Condições traumáticas que resultam muitas vezes em fraturas epifisárias são a causa mais comum das lesões da placa de crescimento. A avaliação cuidadosa desses pacientes pelos métodos de diagnóstico por imagem atualmente disponíveis, sobretudo a radiografia, a tomografia computadorizada e a ressonância magnética, permite o reconhecimento precoce do comprometimento das estruturas relacionadas ao crescimento ósseo, além de tratamento adequado, diminuindo a possibilidade do desenvolvimento de tais complicações.
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Affiliation(s)
| | | | - André Yui Aihara
- Diagnósticos da América; Universidade Federal de São Paulo, Brasil
| | | | | | - André Rosenfeld
- Diagnósticos da América; Universidade Federal de São Paulo, Brasil
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Caine D, DiFiori J, Maffulli N. Physeal injuries in children's and youth sports: reasons for concern? Br J Sports Med 2006; 40:749-60. [PMID: 16807307 PMCID: PMC2564388 DOI: 10.1136/bjsm.2005.017822] [Citation(s) in RCA: 214] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2006] [Indexed: 11/04/2022]
Abstract
A systematic review of the literature on the frequency and characteristics of sports related growth plate injuries affecting children and youth in organised sport was carried out. Both acute and chronic physeal injuries related to participation in sports have been reported to occur, although injury incidence data are somewhat limited. Of particular concern is the growing number of stress related physeal injuries, including those affecting the lower extremities. Although most physeal injuries appeared to resolve with treatment and rest, there is also evidence of growth disturbance and deformity. Possible injury risk factors and countermeasures are discussed, and suggestions for directing future research provided.
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Affiliation(s)
- D Caine
- Department of Physical Education, Health and Recreation, Western Washington University, Bellingham, WA 98225-9067, USA.
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