Maturation-dependent patterns of knee injuries among symptomatic pediatric soccer players on MRI

Vandan Patel; Jude Barakat; Lewis Fanney; Liya Gendler; Naomi J Brown; Theodore J Ganley; Jie C Nguyen

doi:10.1007/s00256-023-04543-w

Maturation-dependent patterns of knee injuries among symptomatic pediatric soccer players on MRI

Skeletal Radiol. 2023 Dec 28. doi: 10.1007/s00256-023-04543-w. Online ahead of print.

Authors

Vandan Patel^{1

2

3}, Jude Barakat^{1

4}, Lewis Fanney^{1

5}, Liya Gendler^{1

6}, Naomi J Brown^{3

6}, Theodore J Ganley^{3

6}, Jie C Nguyen^{7

8}

Affiliations

¹ Department of Radiology, Section of MSK, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
² Drexel University College of Medicine, Philadelphia, PA, USA.
³ Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA.
⁴ University of Pennsylvania School of Engineering and Applied Sciences, Philadelphia, PA, USA.
⁵ Eastern Virginia Medical School, Norfolk, VA, USA.
⁶ Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁷ Department of Radiology, Section of MSK, Children's Hospital of Philadelphia, Philadelphia, PA, USA. nguyenj6@chop.edu.
⁸ Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. nguyenj6@chop.edu.

PMID: 38153433
DOI: 10.1007/s00256-023-04543-w

Abstract

Objective: To systematically investigate the prevalence of knee MRI findings among symptomatic pediatric soccer players with respect to skeletal maturity and to identify predictors of surgery.

Methods: This IRB-approved, HIPAA-compliant retrospective study included soccer players (< 18 years of age) who underwent MRI examinations in the past 5 years (2018-2023). Two radiologists retrospectively and independently reviewed all examinations to categorize skeletal maturity and to identify osseous and soft tissue findings. Findings were compared between maturation groups, and logistic regression models were used to identify predictors of surgery.

Results: Ninety-seven players (45 boys, 52 girls) included 39 skeletally immature, 21 maturing, and 37 mature knees. Kappa coefficient for interobserver reliability ranged between 0.65 and 1.00. Osgood-Schlatter disease (OSD) was more common among immature than maturing and mature knees (25% vs 14% and 5%, p = 0.04); anterior cruciate ligament (ACL) injury was more common among maturing and mature than immature knees (59% and 48%, vs 15%, p < 0.01); and meniscal tears were more common among mature than immature and maturing knees (medial, 41% vs 18% and 14%, p = 0.03; lateral, 43% vs 21% and 19%, p = 0.04). Players in the mature group were more likely to undergo surgery (p = 0.01). The presence of an effusion (OR = 19.5, 95% CI 2.8-240.9, p = 0.01), ACL injury (OR = 170.0, 95% CI 1.3-6996.9, p < 0.01), and lateral meniscal tears (OR = 10.8, 95% CI 1.8-106.1, p = 0.02) were independent predictors of surgery.

Conclusion: Differential patterns of injury were found among symptomatic pediatric soccer players; the presence of an effusion, ACL injury, and lateral meniscal tears were independent predictors of surgery, likely contributing to the higher rates of surgery among skeletally mature players.

Keywords: ACL; Athlete; Children; Football; Fracture; Imaging; Immature knee; Knee; Knee effusion; MRI; Meniscus; Osgood-Schlatter disease; Pediatric; Salter-Harris fracture; Skeletal maturity; Soccer; meniscal tear.