Effectiveness of interventions for treating apophysitis in children and adolescents: protocol for a systematic review and network meta-analysis

Abstract

BackgroundOveruse injuries are reported to be more common than acute trauma in children and adolescents, causing pain and reduced function. The most common is apophysitis - a traction injury to the apophysis in growing individuals. The duration of symptoms reported in the literature is between 6 weeks to 6 months or more. The objective of this systematic review and network meta-analysis is to compare the effectiveness and safety of all available treatments for any type of apophysitis in children and adolescents.Methods/DesignWe will conduct a systematic review to retrieve all relevant studies applying a comparative design. Searches will be made in the Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL and SportDiscus databases and via reference searching. The efficacy of treatments will be compared with respect to the outcomes 1) time to pain-free activity and 2) risk of subsequent injury. Risk of bias assessment will be made using revised tool for assessing risk of bias in randomized trials for Randomized trials and Robins-I tool for non-randomized trials. We will explore if different treatment comparisons are sufficiently similar in terms of effect modifiers (transitivity assumption) with the aim to conduct network meta-analyses for randomized and non-randomized studies separately. A treatment hierarchy will be obtained using the surface under the cumulative ranking curve (SUCRA) and mean ranks, visualized using rankograms. We will use the CINeMA software to apply the modified version of Grades of Recommendation, Assessment, Development and Evaluation (GRADE), developed specifically to evaluate the quality of evidence in network meta-analysis.DiscussionTo date the comparative effects of interventions for apophysitis seem to rely mainly on expert opinion. We aim to identify all comparative treatment designs described in the literature and synthesize data when possible. We will use the estimated treatment effects between injury locations to provide guidance in managing apophysitis.Trial registrationPROSPERO ID number: CRD42018083746.Electronic supplementary materialThe online version of this article (10.1186/s12998-018-0209-8) contains supplementary material, which is available to authorized users.

Apofisitis de la Rodilla (Osgood Schlatter, Sinding Larsen Johansson)

“…13,4 Ocurre por la tracción repetida del tendón rotuliano, a la altura de la tuberosidad anterior de la tibia, generando cargas submáximas, inflamación crónica y cambios osteocondrales por microfracturas en la apófisis de la tuberosidad anterior de la tibia. 14,15,2 Suele aparecer entre los 13 y 15 años en varones y de los 11 a 13 años en mujeres, 3,516 y de manera bilateral en 25 a 50% de los casos, 15,2 con predominio en el género masculino (relación de 3:2). 9…”

“…La fase aguda puede provocar dolor incluso por dos semanas; durante esta fase no hay deformidad ni cambios radiográficos; en la fase crónica es característica la prominencia en la tuberosidad anterior de la tibia, que genera dolor y se percibe dura a la palpación, pero los arcos de movilidad se encuentran conservados. 4,14,5 Entre los factores de riesgo se incluyen todas las actividades deportivas 8,10,11,4 que se practican de manera cíclica y, en especial, las que implican la flexión y extensión repetida de la rodilla, así como saltos o cambios súbitos en la intensidad o frecuencia (futbol, basquetbol, voleibol, atletismo); 8,9,2 otros factores suponen: fase de crecimiento rápido, 7 peso y talla del paciente, 8 mala alineación de las extremidades pélvicas, 8,17 falta de laxitud ligamentaria, 18,4 acondicionamiento físico deficiente, 17,8 lesión previa 8 y entrenamiento de alto rendimiento. 8…”

Knee function and quality of life in adolescent soccer players with Osgood Shlatter disease history: a preliminary study

“…The minimum duration of pain has been reported to be about 6 weeks, but it can last for more than 6 months. There have been reported cases in which pain lasted much longer—a year or even 2 years 8 . Even after treatment intervention, symptoms may remain in some individuals.…”