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Sato VN, Moriwaki TL, Ikawa MH, Sugawara LM, da Rocha Correa Fernandes A, Skaf AY, Yamada AF. Apophyseal injuries in soccer players. Skeletal Radiol 2024:10.1007/s00256-023-04542-x. [PMID: 38224380 DOI: 10.1007/s00256-023-04542-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/05/2023] [Accepted: 12/05/2023] [Indexed: 01/16/2024]
Abstract
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.
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Affiliation(s)
- Vitor Neves Sato
- Department of Radiology, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 - Vila Clementino, São Paulo, SP, 04024-002, Brazil
- Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil
- Division of Musculoskeletal Radiology, Diagnóstico das Américas (DASA), São Paulo, SP, Brazil
| | - Tatiane Lumi Moriwaki
- Department of Radiology, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 - Vila Clementino, São Paulo, SP, 04024-002, Brazil
- Division of Musculoskeletal Radiology, Diagnóstico das Américas (DASA), São Paulo, SP, Brazil
| | - Marcos Hiroyuki Ikawa
- Department of Radiology, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 - Vila Clementino, São Paulo, SP, 04024-002, Brazil
- Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil
- Division of Musculoskeletal Radiology, Diagnóstico das Américas (DASA), São Paulo, SP, Brazil
| | - Leonardo Massamaro Sugawara
- Department of Radiology, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 - Vila Clementino, São Paulo, SP, 04024-002, Brazil
- Division of Musculoskeletal Radiology, Diagnóstico das Américas (DASA), São Paulo, SP, Brazil
| | - Artur da Rocha Correa Fernandes
- Department of Radiology, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 - Vila Clementino, São Paulo, SP, 04024-002, Brazil
- Radiology Department - Grupo de Radiologia e Diagnóstico por Imagem da Rede D'Or, São Paulo, SP, Brazil
| | - Abdalla Youssef Skaf
- Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil
- Division of Musculoskeletal Radiology, Diagnóstico das Américas (DASA), São Paulo, SP, Brazil
| | - André Fukunishi Yamada
- Department of Radiology, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 - Vila Clementino, São Paulo, SP, 04024-002, Brazil.
- Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil.
- Division of Musculoskeletal Radiology, Diagnóstico das Américas (DASA), São Paulo, SP, Brazil.
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Lyng KD, Sørensen LB, Olesen JL, Rathleff MS, Holden S. Do adolescents with Osgood-Schlatter display nociplastic pain manifestations compared to controls: A cross-sectional study. J Sci Med Sport 2023:S1440-2440(23)00085-3. [PMID: 37391284 DOI: 10.1016/j.jsams.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVES Osgood-Schlatter disease is an overuse musculoskeletal pain condition. The pain mechanism is considered nociceptive, but no studies have investigated nociplastic manifestations. This study investigated pain sensitivity and inhibition evaluated through exercise-induced hypoalgesia in adolescents with and without Osgood-Schlatter. DESIGN Cross-sectional study. METHODS Adolescents underwent a baseline assessment comprising clinical history, demographics, sports participation, and pain severity rated (0-10) during a 45-second anterior knee pain provocation test, consisting of an isometric single leg squat. Pressure pain thresholds were assessed bilaterally at the quadriceps, tibialis anterior muscle, and the patella tendon before and after a three-minute wall squat. RESULTS Forty-nine adolescents (27 Osgood-Schlatter, 22 controls) were included. There were no differences in the exercise-induced hypoalgesia effect between Osgood-Schlatter and controls. Overall, an exercise-induced hypoalgesia effect was detected at the tendon only in both groups with a 48 kPa (95 % confidence interval 14 to 82) increase in pressure pain thresholds from before to after exercise. Controls had higher pressure pain thresholds at the patellar tendon (mean difference 184 kPa 95 % confidence interval 55 to 313), tibialis anterior (mean difference 139 kPa 95 % confidence interval 24 to 254), and rectus femoris (mean difference 149 kPa 95 % confidence interval 33 to 265). Higher anterior knee pain provocation severity was associated with lower exercise-induced hypoalgesia at the tendon (Pearson correlation = 0.48; p = 0.011) in participants with Osgood-Schlatter. CONCLUSIONS Adolescents with Osgood-Schlatter display increased pain sensitivity locally, proximally, and distally but similar endogenous pain modulation compared to healthy controls. Greater Osgood-Schlatter severity appears to be associated with less efficient pain inhibition during the exercise-induced hypoalgesia paradigm.
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Affiliation(s)
- Kristian Damgaard Lyng
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark; Center for General Practice at Aalborg University, Denmark. https://twitter.com/kristianlyng_
| | - Line Bay Sørensen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark. https://twitter.com/LineBaySrensen1
| | | | - Michael Skovdal Rathleff
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark; Center for General Practice at Aalborg University, Denmark; Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Denmark. https://twitter.com/MichaelRathleff
| | - Sinead Holden
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark; UCD Clinical Research Centre, School of Medicine, University College Dublin, Ireland.
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Nauta HJA, van der Made AD, Tol JL, Reurink G, Kerkhoffs GM. Satisfactory clinical outcome of operative and non-operative treatment of avulsion fracture of the hamstring origin with treatment selection based on extent of displacement: a systematic review. Knee Surg Sports Traumatol Arthrosc 2021; 29:1813-1821. [PMID: 32809117 PMCID: PMC8126544 DOI: 10.1007/s00167-020-06222-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/06/2020] [Indexed: 12/05/2022]
Abstract
PURPOSE To compare outcome of operative and non-operative treatment of avulsion fractures of the hamstring origin, with minor (< 1.5 cm) and major (≥ 1.5 cm) displacement, and early (≤ 4 weeks) and delayed (> 4 weeks) surgery. METHODS A systematic literature search was performed using PubMed, Cochrane, Embase, CINAHL and SPORTDiscus. A quality assessment was performed using the Physiotherapy Evidence Database (PEDro) scale. RESULTS Eight studies with 90 patients (mean age: 16 years) were included. All studies had low methodological quality (PEDro score ≤ 5). Operative treatment yielded a return to preinjury activity rate (RTPA) of 87% (95% CI: 68-95), return to sports (RTS) rate of 100% (95% CI: 82-100), Harris hip score (HHS) of 99 (range 96-100) and a University of California Los Angeles activity scale (UCLA) score of 100%. Non-operative treatment yielded a RTPA rate of 100% (95% CI:68-100), RTS rate of 86% (95% CI: 69-94), HHS score of 99 (range 96-100), and non-union rate of 18% (95% CI: 9-34). All patients with minor displacement were treated non-operatively (RTPA: 100% [95% CI: 21-100], RTS: 100% [95% CI: 51-100]). For major displacement, operative treatment led to RTPA and RTS rates of 86% (95% CI: 65-95) and 100% (95% CI: 84-100), and 0% (0/1, 95% CI: 0-79) and 100% (95% CI: 51-100) for non-operative treatment. Early surgery yielded RTPA and RTS rates of 100% (95% CI: 34-100 & 57-100) compared to 100 (95% CI: 72-100) and 90% (95% CI: 60-98) for delayed repair. CONCLUSION All included studies have high risk of bias. There is only low level of evidence with a limited number of included patients to compare outcome of operative and non-operative treatment. Overall outcome was satisfactory. There is a treatment selection phenomenon based on displacement, with acceptable outcome in both groups. There is insufficient data to draw conclusions regarding timing of surgery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Hijleke J A Nauta
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
| | - Anne D van der Made
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands.
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands.
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands.
| | - Johannes L Tol
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
- Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Gustaaf Reurink
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
| | - Gino M Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
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Cho HG, Kwon HY, Lee YC, Lee YC, Kweon SH. Osteochondroma formation after avulsion fracture of anterior inferior iliac spine: A case report. World J Orthop 2020; 11:357-363. [PMID: 32904027 PMCID: PMC7448205 DOI: 10.5312/wjo.v11.i8.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/16/2020] [Accepted: 08/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hip avulsion fractures occur mostly during adolescence when actions such as kicking or running cause forceful contraction of attached muscle. Osteochondroma is benign tumor that mostly occurs at the metaphysis of a long bone, being usually asymptomatic.
CASE SUMMARY A 15-year-old patient experienced feeling and sound of a break while kicking a ball in soccer game three years prior to his visit to our hospital. A simple X-ray revealed an avulsion fracture of the apophysis of the anterior inferior iliac spine (AIIS). Later in the follow-up X-ray, a palpable mass was found and demonstrated by magnetic resonance imaging to be a pedunculated osteochondroma in the superolateral aspect of the AIIS. For surgical treatment, we performed osteotomy for surgical excision and excisional biopsy. A mass with smooth surface and an unclear superolateral AIIS border was found intraoperatively. Pathologic exam showed definite diagnosis of osteochondroma. Postoperatively, discomfort during hip flexion was improved, and the hip joint range of motion during walking was recovered at the last follow-up, which was three weeks after the surgery.
CONCLUSION This is a rare case to demonstrate relevant previous trauma history prior to the formation of osteochondroma.
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Affiliation(s)
- Hyung Gyu Cho
- Department of Orthopaedic Surgery, Wonkwang University School of Medicine Hospital, Iksan 54538, South Korea
| | - Hoi Young Kwon
- Department of Orthopaedic Surgery, Wonkwang University School of Medicine Hospital, Iksan 54538, South Korea
| | - Yeong Chang Lee
- Department of Orthopaedic Surgery, Wonkwang University School of Medicine Hospital, Iksan 54538, South Korea
| | - Yong Chan Lee
- Department of Orthopaedic Surgery, Wonkwang University School of Medicine Hospital, Iksan 54538, South Korea
| | - Suc Hyun Kweon
- Department of Orthopaedic Surgery, Wonkwang University School of Medicine Hospital, Iksan 54538, South Korea
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Twu J, Landy DC, Wolf JM. Olecranon Fracture through Persistent Olecranon Apophysis in a 21-Year-Old Male: A Case Report and Systematic Review of the Literature. J Hand Surg Asian Pac Vol 2020; 25:110-113. [PMID: 32000610 DOI: 10.1142/s2424835520720017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Traumatic fractures involving an ununited olecranon apophysis in adults have been rarely documented in the literature. We present the case of a 21-year-old male wrestler with an elbow injury after a fall. Imaging revealed an acute fracture of the olecranon with sclerotic rounded edges indicating an injury through a persistent olecranon apophysis. Open reduction and internal fixation was performed with plate fixation and bone grafting with radiographic and clinical healing at 6 weeks. Review of the literature revealed 5 case reports showing high rates of non-union with tension band constructs while plate and screw fixation had no incidence of nonunion. Fractures through an ununited olecranon apophysis are successfully treated with plate and screw fixation with bone grafting.
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Affiliation(s)
- Jonathan Twu
- Department of Orthopaedic Surgery and Rehabilitation, University of Chicago Hospitals, Chicago, IL, USA
| | - David C Landy
- Department of Orthopaedic Surgery and Rehabilitation, University of Chicago Hospitals, Chicago, IL, USA
| | - Jennifer Moriatis Wolf
- Department of Orthopaedic Surgery and Rehabilitation, University of Chicago Hospitals, Chicago, IL, USA
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Abstract
BACKGROUND Muscular and apophyseal injuries in the inguinal region are a common cause of groin pain in athletes. PURPOSE Frequently occurring muscular and apophyseal injuries in the groin region are described. MATERIAL AND METHODS Fundamental studies and expert recommendations are discussed. Examination protocols for routine clinical practice are presented. RESULTS The exact diagnosis and classification of muscular or apophyseal injuries in the inguinal region are the basic prerequisites for the initiation of a targeted treatment and thus crucial for the return to sport time. These injuries are occurring with increasing frequency in both professional and recreational sports. CONCLUSION In addition to the clinical examination and the history of the course of the injury, MRI plays an important role in the evaluation of muscular and apophyseal injuries in the inguinal region.
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Affiliation(s)
- M G Mack
- Radiologie München, Burgstraße 7, 80331, München, Deutschland.
| | - M Regier
- Radiologie München, Burgstraße 7, 80331, München, Deutschland
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Sinikumpu JJ, Hetsroni I, Schilders E, Lempainen L, Serlo W, Orava S. Operative treatment of pelvic apophyseal avulsions in adolescent and young adult athletes: a follow-up study. Eur J Orthop Surg Traumatol 2017; 28:423-429. [PMID: 29159479 DOI: 10.1007/s00590-017-2074-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/01/2017] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Pelvic apophyseal avulsion can limit young athletes' performance for months and may result in permanent disability. Nonoperative treatment is most commonly preferred, while surgical management with reduction and fixation is reserved for selected cases. Our aim was to evaluate outcomes of operative management of pelvic apophyseal avulsions in a series of adolescents and young adult athletes. MATERIALS AND METHODS Operative room registries and medical records were reviewed to identify patients who received surgical treatment for pelvic apophyseal avulsions who were younger than 24 years and with a minimum of 12 month follow-up. RESULTS Thirty-two patients (16.8 years ± 2.6) were identified. The most common avulsion sites were anterior inferior iliac spine (34.4%, N = 11) and ischial tuberosity (34.4%, N = 11). Other avulsions were five cases (15.6%) of the pubic apophysis, four cases (12.5%) of the anterior superior iliac spine apophysis and one case of the iliac crest apophysis. Seventeen cases (53.1%) underwent surgery early, i.e., during the first 3 months after the acute injury. Twenty-two cases (68.8%) involved reduction with internal fixation, and six cases (18.8%) involved resection of the fragment. Twenty-six athletes (81.3%, N = 26) reported good outcomes and were able to return to preinjury sports level. Six patients (18.8%) had moderate outcome and reported activity limitations during high-level sports. Large displacement (> 20 mm) or delayed (> 3 months) surgery was not associated with inferior outcomes (P = 0.690 and P = 0.392, respectively). Injury side (P = 0.61) or gender (P = 0.345) did not affect outcomes. CONCLUSIONS Operative management of pelvic apophyseal avulsion results in return to the preinjury sports level in more than 80% of the cases. However, while both acute surgery for large displacement and delayed intervention for failed nonoperative treatment are generally successful in improving sports function in these cases, comparative studies are required to refine criteria for surgery. LEVEL OF EVIDENCE Case series, IV.
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Affiliation(s)
- Juha-Jaakko Sinikumpu
- Department of Pediatric Surgery and Orthopedics, Oulu University Hospital, POB 23, 90029 OYS, Oulu, Finland. .,Pedego Research Group, Medical Research Center Oulu, Oulu University, Oulu, Finland. .,Mehiläinen Sports Clinic, Oulu, Finland.
| | - Iftach Hetsroni
- Department of Orthopedic Surgery, Meir General Hospital, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ernest Schilders
- Fortius Clinic, FIFA Medical Centre of Excellence, London, UK.,Leeds Beckett University, Leeds, UK
| | | | - Willy Serlo
- Department of Pediatric Surgery and Orthopedics, Oulu University Hospital, POB 23, 90029 OYS, Oulu, Finland.,Pedego Research Group, Medical Research Center Oulu, Oulu University, Oulu, Finland
| | - Sakari Orava
- Sports Injury Research Center, Hospital NEO, Turku, Finland
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Halanski MA, Abrams S, Lenhart R, Leiferman E, Kaiser T, Pierce E, Franklin RR, Opel D, Noonan KJ, Crenshaw TD. Tendon transfer to unossified bone in a porcine model: potential implications for early tibialis anterior tendon transfers in children with clubfeet. J Child Orthop 2016; 10:705-14. [PMID: 27900541 DOI: 10.1007/s11832-016-0799-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 11/09/2016] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Tibialis anterior tendon transfers (TATT) are commonly performed in young children following Ponseti casting for clubfeet. The classic TATT involves advancing the tendon through a hole drilled in the ossified cuneiform. The aim of this study was to determine if tendons transferred through unossified bones have untoward effects on subsequent bone development. METHOD Twenty-five piglets underwent one of five surgical procedures. An 18-gauge needle was then used to place a tunnel through the bony or cartilaginous portion of the calcaneus (through direct visualization) and isolated slips of the flexor digitorum superficialis (FDS) were placed through the tunnels, as determined by surgical procedure. Radiographic and/or histologic evaluations of the calcaneal apophyses were then performed. A discrete (1-4) and dichotomous "Normal" or "Abnormal" scoring system was developed and its reliability assessed to grade the appearance of the calcanei. Calcaneal appearances following the surgical procedures were then compared with controls. The average load to failure of a subset of transferred tendons was then compared using an MTS machine. RESULTS The proposed apophyseal grading system (1-4) demonstrated an intraclass correlational coefficient (ICC) for consistency of 0.92 [95% confidence interval (CI) 0.88 < ICC < 0.95] and ICC for agreement of 0.91 (95% CI 0.86 < ICC < 0.95), indicating strong agreement and consistency. Similarly, Fleiss' kappa for the 1-4 scoring system was found to be 0.67, indicating substantial agreement between reviewers. When the 1-4 system was translated into the dichotomous scheme "Normal" and "Abnormal", the kappa value increased to 0.94, indicating strong agreement. Forty-six apophyses (13 control and 33 operative) were assessed using this scoring scheme. Apophyseal transfers were significantly more abnormal than controls (p < 0.0001), while no difference in abnormalities was found following tunnel placement alone (p = 1). Mechanical testing of the tendons transferred to bone or through the cartilaginous apophysis demonstrated no significant differences (p = 0.2). CONCLUSION Tendon transfers through unossified bones altered subsequent bone development. SIGNIFICANCE While the long-term consequence of these structural changes is unknown, these findings suggest that tendon transfers through unossified bones should be avoided and alternative methods of tendon fixation explored.
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Abstract
Apophyses are growth zones attached to the shaft (corpus) of larger bones. They vary in size and develop their own ossification centres or form as part of an usually fibrocartilaginous tendon or ligament insertion. The structure of the cartilaginous apophyseal plate is very similar to that of an epiphyseal growth plate and like these they are adapted to withstand perpendicular compressive forces without becoming harmed. This is best highlighted by the fact that their mineralized borders always orient themselves perpendicular to the overall resulting force vector. The edges of the apophyseal plates are characteristically bent which allows them to resist moderate shear forces. Like the epiphyseal plates the apophyseal plates exhibit a zonal organization which is not very well adapted to permanently withstand shear forces, especially if they occur under dynamic conditions. In these situations the tendinous insertions with their collagen fibre anchoring system have to provide compensation when balancing the load transmitted across the system.
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Affiliation(s)
- R Putz
- Anatomische Anstalt, Ludwig-Maximilians-Universität München, Pettenkoferstraße 11, 80336, München, Deutschland.
| | - S Milz
- Anatomische Anstalt, Ludwig-Maximilians-Universität München, Pettenkoferstraße 11, 80336, München, Deutschland
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Heimkes B. [The great apophyses: Functional strain and relevance]. Orthopade 2016; 45:206-212. [PMID: 26846411 DOI: 10.1007/s00132-016-3222-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The structure of apophyses and apophyseal growth plates is not substantially different from those of epiphyses and epiphyseal growth plates. In contrast to epiphyseal growth plates, apophyses and apophyseal growth plates do not contribute to the longitudinal growth of the extremity. They are associated with their adjacent joints, triggering the lengths of their lever arms and influencing their external shape and internal architecture. The formative stimulus on apophyses is given by muscles and tendons inserting at the apophysis or canopying the apophsis. APOPHYSIS OF THE GREATER TROCHANTER The apophysis of the greater trochanter significantly contributes to the lever arm length of the hip joint. Its growth activity triggers the neck-shaft angle and finally the centration of the hip joint. TIBIAL APOPHYSIS The tibial apophysis interacts with the slope of the proximal tibia and hereby influences the sagittal stability of the knee joint. A damage to the growth plate of the tibial tubercle leads to an anteverted tibial slope and a genu recurvatum difficult to treat. CALCANEAL APOPHYSIS The calcaneal apophysis determines the length and position of the calcaneus and herewith influences the torque of the ankle joint. In a nutshell you may regard the apophyses as adjusting screws acting on their adjacent joints and influencing their growth, form and structure.
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Affiliation(s)
- B Heimkes
- Klinik für Kinderchirurgie, Sektion Kinderorthopädie, Klinikum Dritter Orden, München-Nymphenburg, Menzinger Str. 48, 80638, München, Deutschland.
- Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Ludwig-Maximilians-Universität, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
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Nehrbass D, Arens D, Zeiter S. Spontaneous bilateral avulsion fracture of the tuberositas tibiae in a New Zealand White rabbit - a counterpart to Osgood-Schlatter disease in humans? ACTA ACUST UNITED AC 2014; 67:223-7. [PMID: 25435475 DOI: 10.1016/j.etp.2014.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 10/27/2014] [Indexed: 10/24/2022]
Abstract
The first reported case describing a spontaneous bilateral avulsion fracture of the tuberositas tibiae in a New Zealand White rabbit is presented. So far in animals, this condition has been only described in dogs and horses. In humans, this condition is also called Osgood-Schlatter disease (OSD) or syndrome, traction apophysitis of the tibial tubercle (ATT) or patellar tendon enthesopathy of the tibial tuberosity respectively. It is mainly seen in young adolescents coinciding with periods of growth spurts. In humans, its pathogenesis is believed to be caused by repetitive tendon/muscle strain at the insertion of the patellar tendon to the immature tibial tuberosity, which has its own secondary ossification center. Morphologically this case is characterized by bilateral chronic avulsion with incomplete separation of the tuberositas tibae, and proximal dislocation of the patella (patella alta). Despite these marked pathological changes, the animal was clinically without findings. Nevertheless, this case emphasizes the need for thorough clinical and radiological examination of rabbits intended for preclinical research studies prior to study begin, especially in orthopedic research.
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Affiliation(s)
- D Nehrbass
- AO Research Institute Davos, Switzerland.
| | - D Arens
- AO Research Institute Davos, Switzerland
| | - S Zeiter
- AO Research Institute Davos, Switzerland
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Schmidt S, Schiborr M, Pfeiffer H, Schmeling A, Schulz R. Sonographic examination of the apophysis of the iliac crest for forensic age estimation in living persons. Sci Justice 2013; 53:395-401. [PMID: 24188340 DOI: 10.1016/j.scijus.2013.05.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 05/13/2013] [Accepted: 05/28/2013] [Indexed: 10/26/2022]
Abstract
The present study examines the applicability of ultrasound diagnostics in assessing the ossification processes of the apophysis of the Crista iliaca of the pelvis for the purposes of forensic age diagnostics in living persons. To this end, the apophyseal ossification stages were determined in 307 female and 309 male study participants aged between 10 and 25 years. In females, ossification stage I was identifiable at an age of 10.1 years at the earliest (x¯=11.8), ossification stage II at 11.2 years at the earliest (x¯=14.6), ossification stage III at 14.7 years at the earliest (x¯ =18.6), and ossification stage IV at 17.9 years at the earliest (x¯=22.7). In males, ossification stage I was observable from an age of 10.0 years (x¯=11.8), ossification stage II from 10.5 years (x¯=14.9), ossification stage III from 15.6 years (x¯=18.9), and ossification stage IV from 17.4 years (x¯=22.6). In forensic age estimation procedures in living persons, sonographic examination of the iliac crest apophysis makes it possible to minimise exposure of the individual to radiation in accordance with the existing legal basis for the use of X-rays on humans. In application areas with no legal basis to justify X-ray examinations, the accuracy of an age diagnosis can be improved by integrating skeletal maturity as a criterion.
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Affiliation(s)
- S Schmidt
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, D-48149 Münster, Germany.
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Akova B, Okay E. Avulsion of the ischial tuberosity in a young soccer player: six years follow-up. J Sports Sci Med 2002; 1:27-30. [PMID: 24672269 PMCID: PMC3957578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2002] [Accepted: 02/26/2002] [Indexed: 06/03/2023]
Abstract
In this case a seventeen-years-old male soccer player, who sustained an injury while playing football, diagnosed as ischial tuberosity avulsion was reported. Following six-months of a conservative rehabilitation program, the athlete returned to his sports' activities. Six years along he had no complaints and his athletic performance was not deteriorated. In this case report diagnosis, treatment and six-years follow-up results were discussed.
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Affiliation(s)
- Bedrettin Akova
- Department of Sports Medicine, Medical Faculty of Uludaǧ University , 16059 Bursa, Turkey
| | - Ertan Okay
- Department of Sports Medicine, Medical Faculty of Uludaǧ University , 16059 Bursa, Turkey
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