Pelvic Avulsion Injuries in the Adolescent Athlete

Yeager, Kathryn; Silva, Selina R; Richter, Dustin L.

doi:10.1016/j.csm.2020.12.002

Cited by 13 publications

(6 citation statements)

References 14 publications

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“…Plain radiographs are included in the initial diagnostic workup, with anteroposterior and frog-leg lateral views of the pelvis and hip. When negative, but with persistent suspicion of an avulsion, CT or MR may assist if the diagnosis is unclear on initial radiographic evaluation [ 26 ]. These additional images can also visualise more clearly the amount of displacement, possibly influencing choice of treatment.…”

Section: Discussionmentioning

confidence: 99%

Apophyseal Avulsion of the Rectus Femoris Tendon Origin in Adolescent Soccer Players

2022

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Apophyseal avulsions of the rectus femorus tendon (RFT) at the anterior inferior iliac spine (AIIS) can occur in adolescents, often while performing soccer. Patient-reported outcomes (PROMs) and time to return to sport of these patients are relatively unknown. Therefore, the aim of this study was to assess the PROMs and return to sports of patients with AIIS avulsions and compare the results with those reported in the literature. This is a case series of seven consecutive patients presenting at our hospital between 2018 and 2020 with an apophyseal avulsion of the RFT from the AIIS. The patients were assessed with use of the WOMAC and Tegner scores and return to sports was evaluated. All patients were male soccer players (median age 13 years; range, 12–17). They were all initially treated non-operatively. One of the patients subsequently needed excision surgery of a heterotopic ossification because of non-transient hip impingement. All other patients recovered after a period of relative rest. Median time to return to sports was 2.5 months (range, 2–3). At a median follow-up of 33 months (range, 18–45), the WOMAC (median, 100; range, 91–100) and Tegner scores (median, 9; range, 5–9) were high. In accordance with the existing literature, most patients with apophyseal avulsions of the AIIS recover well with non-operative treatment. However, the avulsion can lead to hip impingement due to heterotopic ossifications possibly needing surgical excision. Sport resumption is achievable after 2–3 months, and patient-reported outcomes are highly satisfactory in the long term.

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Section: Discussionmentioning

confidence: 99%

Apophyseal Avulsion of the Rectus Femoris Tendon Origin in Adolescent Soccer Players

2022

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“…6,8 This is followed by the anterior superior iliac spine with another 30% and then the ischial tuberosity with 19%. 6,8 Common mechanisms of injury for the ischial tuberosity avulsion injury are running, sprinting, kicking, and other explosive movement patterns. 3,6 Video Journal of Sports Medicine (VJSMÒ), 4( 2…”

Section: Video Transcriptmentioning

confidence: 99%

Endoscopic Repair of Ischial Tuberosity Avulsion Fracture

Bond,

Scott,

Mather

2024

Video Journal of Sports Medicine

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Background: The ischial tuberosity apophysis serves as an attachment site for the hamstring muscle complex in the pediatric pelvis. Once the apophysis begins to ossify around age 13 to 15 years, decreasing elasticity makes the physis the weakest part of the hamstring attachment to the pelvis. An avulsion injury of the hamstring muscle group in the adolescent therefore results in a fracture in the adolescent and is the functional equivalent to a 3-tendon proximal hamstring injury in an adult. Ischial tuberosity fractures have a higher rate of non-union than other pelvic apophyseal injuries. Endoscopic surgery offers the advantage of smaller incisions, reduced wound complications, and expedited recovery compared with an open procedure. Indications: Controversy exists over which fractures benefit from surgical fixation. Patients with an ischial tuberosity avulsion fracture that is displaced more than 20 mm or that remains symptomatic despite at least 3 months of conservative management are common indications for surgery. Technique Description: The patient is positioned in the prone position and under fluoroscopic guidance 2 endoscopic portals are created. The sciatic nerve is visualized, neurolysis performed, and then protected throughout the remainder of the case. The ischial tuberosity is located along with the avulsed apophysis and hamstring tendon. The bony surfaces are prepared. The fracture fragment is reduced and 3 partially threaded cannulated screws are percutaneously passed across the fracture. The interval between the semimembranosus and conjoined tendons was closed with a suture. Results: There are no results published specific to this technique. Outcome papers are lacking, but cohort studies show significant displacement increases risk for non-union. Displaced ischial tuberosity fractures are also thought to risk sciatic nerve irritation and decreased hamstring strength. Discussion/Conclusion: Recent advancements in periarticular endoscopic surgery of the hip have enabled this historically open procedure to be performed in a minimally invasive fashion. This technique achieves robust fixation of the avulsed fragment and the benefits of anatomic repair of the hamstring origin while avoiding the larger incision and soft tissue dissection required for an open procedure. In time, this technique may become standard of care much like other sports medicine procedures which have transitioned from open to arthroscopic with the development of suitable tools and techniques. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

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“…Various studies state that conservative treatment remains to be the most viable and selected option of treatment. 10 , 11 , 12 , 13 …”

Section: Introductionmentioning

confidence: 99%