Stress-induced Salter-Harris I growth plate injury of the proximal tibia: first report

Nanni, Matteo; Butt, Sajid; Mansour, Ramy; Muthukumar, T; Cassar‐Pullicino, Victor N.; Roberts, Andrew

doi:10.1007/s00256-004-0892-5

Cited by 25 publications

(36 citation statements)

References 25 publications

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“…One may speculate whether this pattern represents irregular growth velocity or early focal physeal closure. Early physeal arrest has been described predominantly in the upper extremities of overhead throwing athletes [13,17].…”

Section: Discussionmentioning

confidence: 99%

Growth Plate Alteration Precedes Cam-type Deformity in Elite Basketball Players

Siebenrock

Behning

Mamisch

et al. 2013

Clinical Orthopaedics &Amp; Related Research

140

146

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Background Vigorous sporting activity during the growth years is associated with an increased risk of having a camtype 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 a closed 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. Highlevel sports activity during growth may be a new and distinct risk factor for a cam-type deformity.

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Section: Discussionmentioning

confidence: 99%

Growth Plate Alteration Precedes Cam-type Deformity in Elite Basketball Players

Siebenrock

Behning

Mamisch

et al. 2013

Clinical Orthopaedics &Amp; Related Research

140

146

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“…During the ossification phase of the epiphysis and the fusion of the apophysis with the metaphysis, this cartilage is under the influence of traction forces. The secondary ossification centres appear between the age of nine and fourteen years and the ossification process is completed between the age of seventeen and nineteen years [5,6,9,11,12]. Furthermore, the epiphysis of the proximal tibia is the second longest epiphysis of the human body after the distal femur.…”

Section: Discussionmentioning

confidence: 97%

“…Fractures of the proximal tibial epiphysis are rare and include 0.3-2.7% of all epiphysiolyses [1][2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Classification of proximal tibial epiphysis fractures in children: Four clinical cases

Aerts

Brinke

Jakma

et al. 2015

Injury

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“…Although most of these stress-related conditions resolved without growth complications during short-term follow-up, there are several reports of stress-related premature partial or complete distal radius physeal closure of young gymnasts 25 26 27 28 29. There are also two reports of varus changes subsequent to sports-related stress injury to the distal femoral and/or proximal tibial physes (rugby and tennis players) 30 31. These data indicate that sport training, if of sufficient duration and intensity, may precipitate pathological changes of the growth plate and, in extreme cases, produce growth disturbance 24 32…”

Section: Physeal Injuries and Growth Disturbancementioning

confidence: 99%

Long-term health outcomes of youth sports injuries

et al. 2009

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Injuries can counter the beneficial effects of sports participation at a young age if a child or adolescent is unable to continue to participate because of residual effects of injury. This paper reviews current knowledge in the field of long-term health outcomes of youth sports injuries to evaluate the evidence regarding children dropping out of sport due to injury, physeal injuries and growth disturbance, studies of injuries affecting the spine and knee of young and former athletes and surgical outcome of anterior cruciate ligament (ACL) reconstruction in children. Studies of dropping out of sport due to injury are limited primarily to gymnasts and implicate such injuries as ACL rupture and osteochondritis dissecans of the elbow joint in the early retirement of young athletes. Although most physeal injuries resolve with treatment and rest, there is evidence of disturbed physeal growth as a result of injury. Radiological findings implicate the effects of intense physical loading and injury in the development of spinal pathology and back pain during the growth of youth athletes; however, long-term effects are unclear. Follow-up studies of young athletes and adults indicate a high risk of osteoarthritis after meniscus or ACL injury. Prospective cohort studies with a follow-up into adulthood are needed to clarify the long-term health outcomes of youth sports injuries. Important to this research is meticulous documentation of injuries on injury report forms that include age-appropriate designations of the type of injury and accurate determination of exposure-based injury rates.

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Stress-induced Salter-Harris I growth plate injury of the proximal tibia: first report

Cited by 25 publications

References 25 publications

Growth Plate Alteration Precedes Cam-type Deformity in Elite Basketball Players

Growth Plate Alteration Precedes Cam-type Deformity in Elite Basketball Players

Classification of proximal tibial epiphysis fractures in children: Four clinical cases

Long-term health outcomes of youth sports injuries

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