CHAPTER 96 • THE PEDIATRIC ATHLETE 563- Some discoid menisci are not diagnosed until they are
torn, in which case the athlete tends to complain of
pain, swelling, and mechanical symptoms. - Diagnosis can often be made on clinical examinaton.
- MRI can also be used to diagnose meniscal tears and
discoid lateral meniscus.
•A torn discoid lateral meniscus requires surgery. If a
discoid lateral meniscus is found incidentally, surgery
is not indicated.
TARSAL COALITION
•Tarsal coalition is a bony or fibrocartilaginous con-
nection of two or more tarsal bones.
- The most common examples are calcaneonavicular
and talocalcaneal coalition. They are often bilateral. - Symptomatic patients typically complain of vague
pain that is insidious in onset. The diagnosis can usu-
ally be made on the oblique view of the plain radi-
ograph, but CT scan may be necessary to provide a
more detailed view of the anatomy. - Conservative therapy includes rest, immobilization,
shoe inserts, and anti-inflammatory medication. - In patients who fail conservative therapy, surgical
resection of the coalition can be undertaken.
ACCESSORY OSSICLES
- The accessory navicular is an accessory ossicle of the
foot into which a portion of the posterior tibialis
inserts. - Athletes involved in sports that stress the posterior
tibialis tendon with repetitive changes in direction,
like basketball, may develop accessory navicular
pain. - Diagnosis can be made on the lateral or external
oblique radiograph of the foot.
•Treatment is typically conservative, with rest, shoe
inserts, and, sometimes, immobilization. Excision can
be performed if conservative therapy fails. - The os trigonum is another common accessory ossicle
that is found posterior to the talus. - Sports that involve repetitive plantar flexion, such as
ballet, can lead to impingement of the os trigonum
between the posterior tibia and calcaneus. - An os trigonum can usually be seen on lateral radi-
ograph of the ankle. - Conservative therapy is usually effective. This
includes physical therapy for strengthening and flexi-
bility, relative rest, anti-inflammatory medication and,
sometimes, immobilization. Excision can be per-
formed if conservative therapy fails.
THE OSTEOCHONDROSES- The osteochondroses are a group of chronic disorders
that involve the epiphyses or apophyses. - They begin as an avascular necrosis of the epiphyseal
center followed by eventual repair and replacement of
the ossification center.
PANNER’S DISEASE•Panner’s disease is an osteochondrosis of the capitel-
lum associated with the repetitive trauma from throw-
ing. It involves variations in the normal ossification of
the capitellum of the humerus. (Sullivan and
Anderson, 2000)- This condition typically affects children between 5
and 11 years of age. - The athlete complains of pain with throwing and may
have swelling of the elbow. - Fragmentation of the capitellum is noted on radi-
ograph of the elbow. - This is a self-limiting disease and can be treated con-
servatively with activity modification.
LEGG-CALVE-PERTHES DISEASE- Osteochondrosis of the femoral head is referred to as
Legg-Calve-Perthes disease. - Symptoms include knee or anterior thigh pain and
limping after activity. - AP and frog lateral radiographs of the hip confirm the
diagnosis. - The main goal of treatment is to maintain range of
motion and prevent deformity of the femoral head by
keeping it contained in the acetabulum. - Orthopedic referral is indicated.
FREIBERG’S DISEASE- Freiberg’s disease is an osteochondrosis of the
metatarsal head. - It usually affects adolescents.
•Forefoot pain is the typical complaint. - Flattening of the metatarsal head and fragmentation of
the growth plate can be seen on plain radiographs.
But, MRI or bone scan may be necessary for diagno-
sis early in the disease process.
•With early diagnosis, conservative therapy, including
relative rest, padding of the affected metatarsal head
and orthotics may be successful. With failure of con-
servative therapy, surgical referral should be made.