DOI: 10.1097/JSM.0b013e31820ebcef

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PMID: 21358507

Issn Print: 1050-642X

Publication Date: 2011/03/01


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Treatment of Iliac Crest Apophysitis in the Young Athlete With Bone Stimulation: Report of 2 Cases

Courtney Grace Kivel; Charles Allou d'Hemecourt; Lyle Joseph Micheli

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Excerpt

One class of sports injuries unique to the child athlete are injuries to the growth cartilage. Growth cartilage in the child is present at the physeal plates of long bones, articular cartilage, and the apophyseal insertions of major muscle tendon units.1 Each of these 3 sites may be injured by acute trauma, repetitive trauma, or combinations of the two, as when an apophysis weakened by repetitive stress is subjected to a single overload and is avulsed from its bony insertion.
Repetitive overuse injuries to the apophysis resulting in pain, swelling, or partial avulsion to the apophyses have been labeled as apophysitises, reflecting earlier observers' beliefs that this involved an inflammatory process. More recently, it has been suggested that these injuries are actually subclinical fractures at these sites, similar to stress fractures seen in the long bones.1-3
There are 7 apophyses located about the hip and pelvis (Figure 1), and all have been reported as sites of both acute traumatic avulsion and apophysitis. Iliac crest apophysitis is relatively rare but is encountered more frequently as an overuse injury than the other peripelvic apophyses.
A study of apophysitises presenting to the Sports Medicine Division of Boston Children's Hospital between 1980 and 1990 reported 32 cases of iliac crest apophysitis out of a total of 445 apophyseal injury cases treated during that time, for a total of 7%.1 Although relatively uncommon, iliac crest apophysitis can be difficult to resolve. Treatments reported include physical therapy, activity modification, anti-inflammatories, and compressive garments.1,3
Risser4 noted that the iliac apophysis appears initially laterally and anteriorly and then ossifies posteriorly progressing on to total bony union. This apophysis is one of the last to close in the body, with the average chronologic age of completion being 16 years in boys and 14 years in girls, but can occur as late as 20 years in boys and 18 years in girls.4
The use of electrical stimulation for the treatment of delayed union of long bone fractures dates back to the 1800s but has only recently been used to treat sports injuries.5
For some years, the senior author (L.J.M.) has been using electrical stimulation to treat not only delayed unions of long bone fractures, but also select cases of osteochondritis dissecans, spondylolysis stress fracture of the low back, and apophysitis.6 Over the past 2 years, he has treated 6 cases of iliac crest apophysitis with adjunct bony stimulation and has had a favorable clinical impression of these outcomes and the ability of these treatments to speed the rate of healing. The clinical and radiographic details of 2 of these cases will be presented below.
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