Overuse injuries in youth sports: is there such a thing as too much sports?

Identification of fractures on pediatric foot radiographs: do localization cues improve diagnostic accuracy and reduce interpretation time?

OBJECTIVE

To investigate the diagnostic accuracy and time in the detection of fractures on pediatric foot radiographs marked without and with localization cues.

METHOD

One-hundred randomly selected foot radiographic examinations that were performed on children (<18 years old) after injury and with at least 4 weeks of follow-up were included. Blinded to history and diagnosis, 4 readers (one each: medical student, pediatrician, pediatric orthopedic surgeon, and pediatric musculoskeletal radiologist) retrospectively and independently reviewed each examination twice (without and with cue, at least 1 month apart, and after randomization). Each reader recorded the presence or absence of a fracture, fracture location, diagnostic confidence, and the total (interpretation) time spent on each study. Diagnostic accuracy, reader confidence, and interpretation time were compared between examinations without and with cues.

RESULTS

Our study included 59 examinations without and 41 with fractures (21 phalangeal, 18 metatarsal, and 2 tarsal fractures). Localization cues improved inter-reader agreement (κ=0.36 to 0.64), overall sensitivity (68 to 72%), specificity (66 to 73%), and diagnostic accuracy (67 to 73%); thus, overcalled and missed rates also improved from 34 to 27% and 32 to 28%, respectively. Reader confidence improved with cue (49 to 61%, p<0.01) with higher incremental improvement with younger children (30% for 1-6 years; 14% for 7-11 years; and 10% for 12-17 years). Interpretation time decreased by 40% per examination (40±22 s without to 24±13 s with cues, p<0.001).

CONCLUSION

Localization cues improved diagnostic accuracy and reader confidence, reducing interpretation time in the detection of pediatric foot fractures.

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

OBJECTIVE

To describe magnetic resonance imaging (MRI) findings in professional soccer players with acute apophyseal injury of the hip and to assess their relationship with return to sports.

MATERIAL AND METHODS

Adolescent soccer players with diagnosis of apophyseal injury in the anterosuperior and anteroinferior iliac spine were retrospectively evaluated between 2008 and 2016. All athletes underwent hip MRI examination within 4 days after onset of clinical complaint. Images were independently analyzed by two radiologists. Medical records were reviewed to obtain clinical data.

RESULTS

Mean displacement of the apophysis was 4.8 ± 4.6 mm. Bone edema was present in 82% of athletes and muscular edema in 41%. The mean time to return to sports was 37.3 ± 14.7 days. The difference between the measurements of the two radiologists was close to zero with agreement limits below 1.0 mm (p < 0.001). There was a significant correlation between displacement of the apophysis and return to sports, as well as between both and the presence of muscular edema. A displacement of the apophysis of 3.0 mm might serve as a parameter to predict return to sports/activity before 40 days, with a sensitivity of 92% and specificity of 96%, considering conservative physiotherapy treatment.

CONCLUSION

Displacement of the apophysis and presence of muscular edema evaluated by MRI showed a significant correlation with return to sports in athletes with acute apophyseal injuries of the anterosuperior and anteroinferior iliac spines.

John L, Brundage K, Borschneck DP. Cross-Sectional Risk Factors of Anterior Knee Pain in Adolescents

Background: Anterior knee pain is a common complaint amongst adolescents, which can both be persistent, and in some cases, disabling. This study investigated a series of potential risk factors potentially linked to the onset of anterior knee pain. Methods: Questionnaires were distributed amongst 367 10-15 years-olds enrolled in the local school board. These surveys included questions on sex, age, sport participation, and history of anterior knee pain verified by a physician. Bivariate correlations and a binomial logistic regression were conducted. Overall rate of AKP in the population studied was 7.4%. The results indicated that past history of knee pain, age, and increased sports participation significantly correlated with increased risk of AKP. AKP was significantly more common in females than males. While sex, height, age, overall sport participation, participation in specific sports, and history of knee injury all contributed to the binomial model.

Young female handball players and sport specialisation: how do they cope with the transition from primary school into a secondary sport school?

OBJECTIVE

The aim of the present study was to examine how six young female handball players (aged 13-14 years) perceived the transition from primary school to a sport-specialised secondary school.

METHODS

Physical and physiological data as well as data from questionnaires were collected at baseline and after the first year at the sport school, and qualitative interviews were performed retrospectively after the first year at school.

RESULTS

Evidence of competition-related stressors, organisational stressors (sport and school balance) and personal stressors (social life and sport balance, lack of sleep and severe injuries) was found. Three girls developed long-lasting musculoskeletal injuries (>3 months out of ordinary training) and one experienced repeated short periods (≤2 weeks out of ordinary training) of injuries during the first year. Onset of menarche and a length growth between 6 and 8 cm during the first year were characteristic traits of the four injured girls.

CONCLUSIONS

From our small study, it appears that young athletes attending a specialised secondary sport school experienced many stressors due to a significant increase in training volume, reduction in sleeping time and development of severe and long-lasting injuries. Hence, trainers at sport schools, club trainers and parents need to communicate and support them in order to prevent this.

Management of Syndesmotic Ankle Injuries in Children and Adolescents

Pediatric ankle injuries are common, especially in athletes; however, the incidence of syndesmosis injuries in children has been scarcely reported. Injuries to the ankle syndesmosis, termed "high ankle sprains," can affect high-level and recreational athletes and have been related to delayed return to play, persistent pain, and adult injuries have been associated with long-term disability. Syndesmotic injuries do occur in children, especially those who participate in sports that involve cutting and pivoting (football, soccer) or sports with rigid immobilization of the ankle (skiing, hockey). Unstable pediatric syndesmosis injuries requiring surgical fixation are often associated with concomitant fibular fracture in skeletally mature children. Physician vigilance and careful clinical examination coupled with appropriate radiographs can determine the extent of the injury in the majority of circumstances.

Characteristics and associated factors with sports injuries among children and adolescents

BACKGROUND:

The participation of children and adolescents in sports is becoming increasingly common, and this increased involvement raises concerns about the occurrence of sports injuries.

OBJECTIVES:

To characterize the sports injuries and verify the associated factors with injuries in children and adolescents.

METHOD:

Retrospective, epidemiological study. One thousand three hundred and eleven children and adolescents up to 18 years of age enrolled in a sports initiation school in the city of Presidente Prudente, State of São Paulo, Brazil. A reported condition inquiry in interview form was used to obtain personal data and information on training and sports injuries in the last 12 months. Injury was considered any physical complaint resulting from training and/or competition that limited the participation of the individual for at least one day, regardless of the need for medical care.

RESULTS:

The injury rate per 1000 hours of exposure was 1.20 among the children and 1.30 among the adolescents. Age, anthropometric data, and training characteristics only differed with regard to the presence or absence of injuries among the adolescents. The most commonly reported characteristics involving injuries in both the children and adolescents were the lower limbs, training, non-contact mechanism, mild injury, asymptomatic return to activities, and absence of recurrence.

CONCLUSIONS:

The injury rate per 1000 hours of exposure was similar among children and adolescents. Nevertheless, some peculiarities among adolescents were observed with greater values for weight, height, duration of training, and weekly hours of practice.

Characteristics and contributing factors related to sports injuries in young volleyball players

Background

The participation of young in volleyball is becoming increasingly common, and this increased involvement raises concerns about the risk of installation of sports injuries. Therefore, the objectives the study were identify the characteristics of sports injuries in young volleyball players and associate anthropometric and training variables with contributing factors for injuries.

Methods

A total of 522 volleyball players participating in the High School Olympic Games of the State of São Paulo (Brazil) were interviewed. A reported condition inquiry was used to gather information on injuries, such as anatomic site affected, mechanism and moment of injury, as well as personal and training data. The level of significance was set at 5%.

Results

A 19% frequency of injuries was found. Higher age, weight, height, body mass index and training duration values were associated with the occurrence of injuries. The most affected anatomic site was the ankle/foot complex (45 injuries, 36.3%). Direct contact and contactless mechanisms were the main causes of injuries (61 injuries; 49.2% and 48 injuries; 38.7%, respectively). Training was the moment in which most injuries occurred (93 injuries; 75%), independently of personal and training characteristics.

Conclusion

Injuries affected the ankle/foot complex with a greater frequency. Direct contact and contactless mechanisms were the most frequently reported and injuries occurred mainly during training sessions. Personal and training characteristics were contributing factors for the occurrence of injuries.

Approach to the patient with noninflammatory musculoskeletal pain

Musculoskeletal pain is one of the most common presenting symptoms at the pediatrician's office. Etiology ranges from benign conditions to serious ones requiring prompt attention. This article addresses entities that present as musculoskeletal pain but are not associated with arthritis. The most common nonarthritic conditions are benign limb pain of childhood (growing pains), hypermobility, overuse syndromes with or without skeletal abnormalities, malignancies, and pain amplification syndromes. The| initial decision process, diagnosis, and treatment options for each of these conditions are discussed.