Research Review – The Apophysis

 

When I give lectures on growth plate problems, I often present a slide with an x-ray of a knee in a kid who hasn’t fully finished their growth. I outline where the physis, or the growth plate, is. Then we show the metaphysis, or the area between the growth plate and the shaft of the bone, then the epiphysis, the area between the growth plate and the joint space, and finally the diaphysis, or the shaft of the bone. Then I generally ask the audience, where is the apophysis? Often, I get crickets. In medicine, we often talk about all the main centers of growth but seem to skip over the apophysis, which is a source of many problems in the growing athlete from overuse.

What exactly is the apophysis? It’s an area of growing bone that doesn’t provide longitudinal (or length) growth of the bone but is a tendon attachment site. We see overuse traction problems in these areas all the time like Osgood-Schlatter in the knee affecting the tibial tubercle, little league elbow affecting the medial epicondyle of the distal humerus or Sever’s in the heel affecting the calcaneus. Today on the latest Research review episode, I will be discussing some recent research about apophyseal problems.

 

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— Gaulrapp H, Nührenbörger C. The Osgood-Schlatter disease: a large clinical series with evaluation of risk factors, natural course, and outcomes. Int Orthop. 2022 Feb;46(2):197-204. doi: 10.1007/s00264-021-05178-z. Epub 2021 Aug 24. PMID: 34427770. https://pubmed.ncbi.nlm.nih.gov/34427770/

— Moeller JL, Galasso L. Pelvic Region Avulsion Fractures in Adolescent Athletes: A Series of 242 Cases. Clin J Sport Med. 2022 Jan 1;32(1):e23-e29. doi: 10.1097/JSM.0000000000000866. PMID: 32941369. https://pubmed.ncbi.nlm.nih.gov/32941369/

— Materne O, Chamari K, Farooq A, Tabben M, Weir A, Holmich P, Bahr R, Greig M, McNaughton LR. Shedding light on incidence and burden of physeal injuries in a youth elite football academy: A 4-season prospective study. Scand J Med Sci Sports. 2022 Jan;32(1):165-176. doi: 10.1111/sms.14059. Epub 2021 Oct 18. PMID: 34551163.https://pubmed.ncbi.nlm.nih.gov/34551163/

— Moeller JL. Pelvic Avulsion Fractures in Adolescent Athletes: Analyzing the Effect of Delay in Diagnosis. Clin J Sport Med. 2022 Jul 1;32(4):368-374. doi: 10.1097/JSM.0000000000000977. Epub 2021 Sep 15. PMID: 35762861. https://pubmed.ncbi.nlm.nih.gov/35762861/

 

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Dr. Mark Halstead - Host of The Pediatric Sports Medicine Podcast - St. Louis, MOMark Halstead: 

Dr. Mark Halstead received his medical degree from the University of Wisconsin Medical School. He stayed at the University of Wisconsin for his pediatric residency, followed by a year as the chief resident. Following residency, he completed a pediatric and adult sports medicine fellowship at Vanderbilt University. He has been an elected member to the American Academy of Pediatrics (AAP) Council on Sports Medicine and Fitness and the Board of Directors of the American Medical Society for Sports Medicine (AMSSM). He has served as a team physician or medical consultant to numerous high schools, Vanderbilt University, Belmont University, Washington University, St. Louis Cardinals, St. Louis Blues, St. Louis Athletica, and St. Louis Rams. He serves and has served on many local, regional and national committees as an advisor for sports medicine and concussions. Dr. Halstead is a national recognized expert in sport-related concussions and pediatric sports medicine.

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