DOI:10.2214/AJR.06.5081.1
AJR 2006; 187:W555
© American Roentgen Ray Society
Reply
Tal Laor,
Eric Wall and
Louis Vu
Cincinnati Children's Hospital Medical Center University of
Cincinnati College of Medicine Cincinnati, OH
WEB—This is a Web exclusive article.
We thank Dr. Ehara for his interest in our article "Physeal Widening
in the Knee Due to Stress Injury in Child Athletes"
[1]. However, we take issue
with several of the points raised. First, we disagree with the statement about
the mildness of the physeal changes seen in elite child athletes. In our
practice, where imaging is performed on more than 600 pediatric knees each
year, we remain impressed by the striking physeal abnormalities shown on MRI
in these children, rather than mild changes as suggested by Dr. Ehara. These
changes can, however, appear subtle on conventional radiographs.
We agree that physeal widening is frequently seen as a result of a wide
variety of metaphyseal insults not limited to child athletes, as we reported
previously [2]. We described
two types of widening: the focal "tonguelike" extension and the
more broad region. The focal physeal extensions were seen in children with
isolated traumatic events, infection, and limited radiation therapy and often
extended to a growth recovery line that developed at the time of the insult.
The broader widening was seen in sustained or repetitive insults, such as
sport activities, spinal dysraphism, and longterm steroid therapy. We found a
statistically significant difference between the type of activity (single
event versus sustained or repetitive trauma) and the morphology of the type of
physeal widening. The figures submitted by Dr. Ehara are different than the
cases we presented in our recent article
[1] in that they show a focal
(tonguelike) area of metaphyseal signal abnormality that corresponds to areas
of sclerosis on radiography in addition to abnormal epiphyseal signal. This
pattern suggests the sequela of an acute injury to the medial aspect of the
tibia rather than the sustained insult seen in elite athletes.
In our experience, the injuries seen in elite athletes are not common in
ordinary nonathlete children. Likewise, a well-controlled article evaluating
these physeal injuries in adolescent gymnasts showed a statistically
significantly greater prevalence than in a control group of nonathletes
[3].
We hoped to convey the importance of recognizing the broad pattern of
physeal widening in child athletes reported in our article. These children, if
not placed at rest to allow healing, may suffer long-term malalignment. This
characteristic appearance must be recognized by any radiologist interpreting
musculoskeletal MRI examinations in children.
References
- Laor T, Wall EJ, Vu LP. Physeal widening in 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]
- Chang CY, Shih C, Penn IW, Tiu CM, Chang T, Wu, JJ. Wrist injuries
in adolescent gymnasts of a Chinese opera school: radiographic survey.
Radiology 1995;195
: 861-864[Abstract/Free Full Text]
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Top
References
