Education And Debate

ABC of Sports Medicine: Musculoskeletal Injuries in Child Athletes

BMJ 1994; 308 doi: (Published 11 June 1994) Cite this as: BMJ 1994;308:1556

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  1. L Klenerman

    The growing skeletons of children may be injured more easily than the mature skeletons of adults because the bones are more porous and the long bones are further weakened by the epiphysical plates at their proximal and distal ends. Children and young teenagers nevertheless have a lower injury rate from participation in sport than fully mature adolescents.

    Children's v adults' skeletons

    More vulnerable because:

    • Still growing

    • More porous

    • Long bones weakened by epiphysial plates at each end

    • Lower injury rate because:

    • More flexible


    Osteochondroses are a loose grouping of conditions affecting the growing epiphysis. They all show healing in radiographs. Common examples that occur in growing children at traction epiphyses are Osgood-Schlatter disease (at tibial tuberosity), Sever's disease (at insertion of Achilles tendon), and Larsen-Johansson disease (at lower pole of patella). Others that affect articular surfaces are Freiberg's disease (head of second or third metatarsal) and Panner's disease (capitellum). These disorders result because physical activity in vigorous growing children produces stresses at the bone-ligament junction or on articular surfaces.

    Osgood-Schlatter disease is caused by a traumatic avulsion of the patellar tendon from the tibial tuberosity and occurs commonly in children aged 11-13. There is pain and discomfort over the tibial tuberosity after exercise. Examination shows local tenderness and prominence of the tuberosity. The best treatment is to ignore the symptoms. Parents should be advised that symptoms usually last for 12-18 months. Rest will relieve the pain. If the children wish to be active they will aggravate their symptoms but come to no harm. Surgery is rarely required but may be necessary for excision of unfused ossicles deep in the ligamentum patellae. These cause pain on kneeling in adulthood.

    Larsen-Johansson disease has a similar pattern of symptoms to Osgood- Schlatter disease but occurs at the lower pole of the patella owing to traction by the …

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