Long‐term outcome of conservatively treated lower limb apophyseal injuries in children and adolescents: A systematic review

Abstract

Apophyseal injuries are generally believed to run a self‐limiting course, suggesting conservative treatment is indicated. We summarized the long‐term consequences of lower limb apophyseal injuries after conservative treatment. We conducted a systematic review using the Cochrane methodology, and reported findings according to PRISMA. MEDLINE, EMBASE, Cochrane CENTRAL, PEDro, and SPORTDiscus were searched. Studies had to include participants aged 8‐18 years old, with a clinical diagnosis of apophyseal injury in the lower limb, more specifically Sever's disease, Osgood‐Schlatter disease, or Sinding‐Larsen‐Johansson disease, non‐surgically treated, with a minimum follow‐up time of 1 year, and with at least one of the following outcome measures: pain, secondary structural changes, functional outcome, participation in sports, and recurrent or subsequent injury. PROSPERO registration number: CRD42020146412. Twelve studies on Osgood‐Schlatter disease, three studies on Sever's disease, and no studies on Sinding‐Larsen‐Johansson disease met inclusion criteria. Results of studies varied widely. Important limitations were heterogeneity between studies and lack of high‐quality research studies. Apophyseal injuries do not always appear to be self‐limiting, with some patients experiencing pain, secondary structural changes, a worse functional outcome, and difficulty resuming sports after more than 1 year of follow‐up.