DOI:10.2214/AJR.06.5081
AJR 2006; 187:W554
© American Roentgen Ray Society
Physeal Stress Injury in the Knee
Shigeru Ehara
Iwate Medical University School of Medicine Morioka, Japan
WEB—This is a Web exclusive article.
I read with interest the article titled "Physeal Widening in the Knee
Due To Stress Injury in Child Athletes" in a recent issue of
AJR [1]. The authors
of that article reported their findings in six child athletes, who ranged in
age from 6 to 15 years, with physeal stress injury representing physeal
widening. This study was a case series study without a nonathlete control.
Although I do not have much experience with child athletes, I have found that
traumatic physeal change was common in ordinary children of the same age group
in our population (Figs. 1A and
1B), as one of the authors has
reported previously [2]. I was
impressed by the fact that the child athletes in the study were well managed
considering the high level of athletic activities and the mildness of physeal
changes.
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Fig. 1A —10-year-old girl with no athletic activities who complained
of knee pain. Anteroposterior radiograph of knee shows slightly widened medial
physis of proximal tibia with linear sclerosis on metaphyseal side.
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Fig. 1B —10-year-old girl with no athletic activities who complained
of knee pain. T1-weighted coronal MR image shows low-signal bands in
metaphysis and epiphysis and blurring of physis. These findings confirm
physeal injury with scar in metaphysis. Pain was transient, and no deformity
was noted.
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Because we have MRI as a screening method, we often observe traumatic
change in ordinary children who participate in only recreational sports or
physical education class. I think that partially closed physes are weak links
in children and that asymmetrically or partially closed physes may be
vulnerable to trauma. Physeal injury with widening in this article
[1] is not unique or specific
to athletes. I would like to draw attention to the fact that physeal stress
injuries may be more common in ordinary, nonathlete children, although
organized research may be needed.
References
- Laor T, Wall EJ, Vu LP. Physeal widening of the knee due to stress
injury in child athletes. AJR 2006;186
: 1260-1264[Abstract/Free Full Text]
- Laor T, Hartman AL, Jaramillo D. Local physeal widening on MR
imaging: an incidental finding suggesting prior metaphyseal insult.
Pediatr Radiol 1997;27
: 654-662[CrossRef][Medline]
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