Hip apophyseal injuries in soccer players: can MRI findings be useful to define when to return to play?

Apophyseal injuries in soccer players

Soccer is the most popular sport worldwide, and it is associated with high injury rates, with most of these injuries occurring in the lower extremities. Particularly, in youth soccer players with immature skeleton, the physeal plate is two to five times weaker than the surrounding fibrous structures, and therefore more vulnerable to injury. The physeal plate consists of epiphyses and apophyses, with the former serving as tendon attachment sites and being subject to traction forces. There are two types of apophyseal injury: (i) apophyseal avulsion, which consists of an acute separation across the physeal plate; and (ii) apophysitis, an injury caused by chronic and repetitive contraction of musculotendon unit, leading to inflammation of the growth plate cartilage. Apophyses of the hip and pelvis are the most commonly injured in youth soccer players, due to vigorous contractions during sports activities and the fact that they tend to fuse later compared to other epiphyseal centers, making them more susceptible to injury. In this review, we will discuss the anatomy of lower limb apophyses and clinical and imaging findings of apophyseal injuries in youth soccer players, as well as briefly review treatment options and complications.

Imaging of sports injuries in adolescents

Musculoskeletal injuries in adolescents tend to occur in particular locations and have distinct characteristics, as they affect an immature skeleton. Increased engagement in sports, extended training and competition periods, and early specialization in specific sports, among other factors, have contributed significantly to the rise in musculoskeletal sports injuries in adolescents. Furthermore, females show a particularly pronounced increase in sports participation, where anatomical and hormonal factors play crucial roles in the development and increased frequency of sports-related injuries. Consequently, there is a growing demand for diagnostic imaging techniques. Musculoskeletal and pediatric radiologists require a comprehensive understanding of intrinsic and extrinsic risk factors and the successive stages of skeletal development that can influence the specific characteristics of sports injuries in adolescents. These aspects are crucial for the diagnostic, prognostic, and therapeutic management of these injuries and for mitigating chronic conditions that could compromise future sports participation. This review analyzes the primary musculoskeletal injuries in adolescent athletes and highlights the pivotal role of different imaging methods in their diagnosis and management.

Consensus on maturity-related injury risks and prevention in youth soccer: A Delphi study

The aim of this study was to achieve consensus from leading sport and exercise science practitioners in professional soccer academies surrounding (i) motivations for maturity-related data collection (ii) maturity-related injury risk factors (iii) how maturity-related data informs injury prevention practices and (iv) the use of bio-banding as an alternative injury prevention strategy. The study adopted an iterative three round online Delphi method, where a series of statements were rated by expert panellists. Consensus agreement was set at ≥70% for all statements. Nine panellists participated in all three rounds (69% response rate). Consensus was achieved for a total of sixteen statements. Panellists agreed that the period during and 12-months post peak height velocity, muscle strength/flexibility imbalances and maturity status (% predicted adult height) as the most important maturity-related injury risk factors. Panellists also agreed that maturity-related data collection is important for injury prevention as well as physical and performance-related purposes, but not for recruitment or retain/release purposes. It was also evident that variability and misunderstanding of key language terms used within the growth and maturation literature exists. It was agreed that practitioners who are responsible for conducting maturational assessments require additional training/education to enhance their application, delivery and outcomes. The findings indicate that maturity-related data collection is part of a multidisciplinary process, dedicated towards the long-term development of players. Greater training and education are required along with increased dissemination of research findings surrounding the full uses for bio-banding. This study provides guidance on maturity-related injury risks and prevention in youth soccer for practitioners.