Apophysitis and Osteochondrosis: Common Causes of Pain in Growing Bones.

Apophysitis and osteochondrosis are common causes of pain in growing bones but have differing etiologies and required management. Apophysitis results from a traction injury to the cartilage and bony attachment of tendons in children and adolescents. Most often it is an overuse injury in children who are growing and have tight or inflexible muscle tendon units. Although apophysitis occurs in upper and lower extremities, it occurs more often in the lower extremities, with common locations including the patellar tendon attachment at the patella or tibia (i.e., Larsen-Johansson and Osgood-Schlatter diseases), the calcaneus (i.e., Sever disease), and multiple locations around the hip, including the anterior inferior iliac spine. Other locations include the medial epicondyle, which is common in patients who throw or participate in racket sports, and more rarely at the base of the fifth metatarsal (i.e., Iselin disease). Radiography can be helpful in evaluating for other pathologies but is usually not necessary. Treatment includes stretching the affected muscle groups, relative rest, offloading the affected tendon, icing after activity, and limited use of nonsteroidal anti-inflammatory drugs. Osteochondrosis presents less commonly and refers to degenerative changes in the epiphyseal ossification centers of growing bones. Unlike apophysitis, the etiology of osteochondrosis is unknown. Multiple possible etiologies have been explored, including genetic causes, hormonal imbalances, mechanical factors, repetitive trauma, and vascular abnormalities. Other locations of osteochondrosis include the second metatarsal head (i.e., Freiberg disease), the navicular bone (i.e., Köhler bone disease), the femoral head (i.e., Legg-Calvé-Perthes disease), and the capitellum (i.e., Panner disease). Radiography results may be normal initially; magnetic resonance imaging is more sensitive to early changes. Osteochondrosis generally resolves with relative rest, but close monitoring is needed to ensure resolution. Surgery is rarely needed for either apophysitis or osteochondrosis.

Sports-related overuse injuries in children.

Increased intensity of sports activities combined with a decrease in daily physical activity is making overuse injuries in children more common. These injuries are located mainly in the epiphyseal cartilage. The broad term for these injuries is osteochondrosis, rather than osteochondritis, which more specifically refers to inflammatory conditions of bone and cartilage. The osteochondrosis may be epiphyseal, physeal, or apophyseal, depending on the affected site. The condition can either be in the primary deformans form or the dissecans form. While there is no consensus on the etiology of osteochondrosis, multiple factors seem to be involved: vascular, traumatic, or even microtraumatic factors. Most overuse injuries involve the lower limbs, especially the knees, ankle and feet. The most typical are Osgood-Schlatter disease and Sever's disease; in both conditions, the tendons remain relatively short during the pubescent grown spurt. The main treatment for these injuries is temporary suspension of athletic activities, combined with physical therapy in many cases. Surgery may be performed if conservative treatment fails. It is best, however, to try to prevent these injuries by analyzing and correcting problems with sports equipment, lifestyle habits, training intensity and the child's level of physical activity, and by avoiding premature specialization. Pain in children during sports should not be considered normal. It is a warning sign of overtraining, which may require the activity to be modified, reduced or even discontinued.

The influence of dietary restriction before and after 10 weeks of age on osteochondrosis in growing gilts.

Osteochondrosis (OC) is one of the main causes of leg weakness causing premature culling in breeding sows and develops in a short time frame in young growing gilts. Dietary restriction may have different effects on OC prevalence depending on the age of the gilts. The aim of this study is to investigate age-dependent effects of dietary restriction, ad libitum vs. restricted (80% of ad libitum), on the occurrence of OC in gilts at slaughter (26 wk of age). At weaning (4 wk of age), 211 gilts were subjected to one of 4 treatments of a feeding regime. Gilts were administered either ad libitum feeding from weaning until slaughter (AA); restricted feeding from weaning until slaughter (RR); ad libitum feeding from weaning until 10 wk of age, after which gilts were switched to restricted feeding (AR); or restricted feeding from weaning until 10 wk of age, after which gilts were switched to ad libitum feeding (RA). At slaughter, the elbow, hock, and knee joints were harvested. Joints were scored macroscopically for articular surface deformations indicative of OC. Gilts in the RA treatment had significantly higher odds of being affected by OC than gilts in the RR and AR treatments in the hock joint (OR=3.3, P=0.04 and OR=8.5, P=0.002, respectively) and at animal level (OR=2.5, P=0.001 and OR=1.9, P=0.01, respectively). Gilts in the AA treatment had higher odds of being affected by OC than gilts in the AR treatment in the hock joint (OR=5.3, P=0.01). The results indicate a possible pathway to reduce the prevalence of OC in breeding gilts that will have to last several parities. Switching from restricted feeding to ad libitum feeding after 10 wk of age increases OC prevalence as opposed to restricted feeding after 10 wk of age.

Effects of 25-hydroxy-cholecalciferol on the development of osteochondrosis in swine.

The principal objective of this experiment was to evaluate the effect of 25-hydroxy-cholecalciferol (25-OH-D3 ) on the development of osteochondrosis in 6- to 110-kg castrated male pigs. The growth rate and serum calcium and inorganic phosphate levels neither increased nor decreased in response to supplementation of 25-OH-D3 . However, supplemental 25-OH-D3 significantly increased serum levels of 25-OH-D3 and 1α,25-hydroxy-cholecalciferol without any influence on bone mineral density. The 25-OH-D3 -treated group had significant (P < 0.05) reduced incidence of osteochondrotic lesions compared to the control group as evidenced by macroscopically examining the articular cartilage of the distal humerus (32.4% vs. 59.3%) and distal femur (47.1% vs. 87.5%). Likewise, supplemental 25-OH-D3 significantly reduced osteochondrotic lesions over the control when histologically examining humerus (20.6% vs. 43.8%) and femur (52.9% vs. 87.5%). The results of this experiment suggested that 25-OH-D3 supplementation in pig diets had a tendency to promote normal endochondral ossification, inhibit osteochondrosis progression and possibly regenerate destroyed cartilage tissue.

A wire-flooring model for inducing lameness in broilers: evaluation of probiotics as a prophylactic treatment.

Bacterial chondronecrosis with osteomyelitis (BCO) is the most common cause of lameness in commercial broilers. Bacteria entering the blood via translocation from the respiratory system or gastrointestinal tract spread hematogenously to the proximal epiphyseal-physeal cartilage of rapidly growing femora and tibiae, causing BCO. We tested the hypothesis that rearing broilers on wire flooring should increase the incidence of BCO by persistently imposing additional torque and shear stress on susceptible leg joints. We also tested the hypothesis that probiotics might attenuate bacterial translocation and thereby reduce the incidence of BCO. In 5 independent experiments using 4 commercial lines, broilers grown on wire flooring developed lameness attributable predominately to BCO. The fastest-growing birds were not necessarily the most susceptible to lameness on wire flooring, nor did the genders differ in susceptibility in the 2 experiments that included both male and female broilers. The pathogenesis of BCO is not instantaneous, and accordingly, many broilers that did not exhibit lameness, nevertheless, did possess early pathognomonic lesions. These subclinical lesions were equally likely to develop in the right or left leg. The lesion status of the proximal femoral head did not determine the lesion status of the ipsilateral or contralateral proximal tibial head and vice versa. Broilers reared on wire flooring consistently had higher incidences of lameness than hatch-mates reared on wood-shavings litter. Adding probiotics to the diet beginning at 1 d of age consistently reduced the incidence of lameness for broilers reared on wire flooring. These experiments indicate that probiotics administered prophylactically may constitute an alternative to antibiotics for reducing lameness attributable to BCO. Rearing broilers on wire flooring provides an important new research model for investigating the etiology, pathogenesis, and treatment strategies for BCO.

Prevalence and associated factors of Osgood-Schlatter syndrome in a population-based sample of Brazilian adolescents.

BACKGROUND: Osgood-Schlatter (OS) syndrome is a disease of the musculoskeletal system often observed during the bone growth phase in adolescents. HYPOTHESIS/ PURPOSE: Demographic and anthropometric factors and those linked to the practice of sports may be related to the prevalence of OS. The aim of the present study was to describe the epidemiologic profile and associated factors of individuals with OS syndrome in a population-based sample of Brazilian adolescents. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A cross-sectional study was conducted with 956 adolescent students (474 boys, 482 girls) from 2008 to 2009 enrolled in the school system of Natal, Brazil. The age ranged between 12 and 15 years (13.7 ± 1.04 years). Tests were performed to assess the anthropometric and clinical aspects related to OS. To confirm the diagnosis of OS syndrome, the participant had to fulfill all the following clinical criteria: pain with direct pressure on the tibial apophysis; aforementioned pain before, during, and after physical activities; enlargement or prominence of the tibial apophysis; pain with resisted knee extension; and pain from jumping. RESULTS: The prevalence of OS in the sample was 9.8% (11.0% of boys and 8.3% of girls; boys, 13.5 ± 1.07 years; girls, 13.6 ± 1.01 years). The results showed that 74.6% of the students suffered from muscle shortening. Multivariate analysis using logistic regression showed that the factors associated with the presence of OS were the regular practice of sport activity (odds ratio, 1.94; 95% confidence interval, 1.22-3.10) and the shortening of the rectus femoris muscle (odds ratio, 7.15; 95% confidence interval, 2.86-17.86). CONCLUSIONS: The regular practice of sports in the pubertal phase and the shortening of the rectus femoris muscle were the main factors associated to the presence of OS syndrome in the students.

Aetiology and prevention of injuries in elite young athletes.

Sport participation confers many varied benefits in children and adolescents, such as self-esteem, confidence, team play, fitness, agility and strength. Nevertheless, the age of initiation of intense training is decreasing and programmes which expose children to excessive amounts of exercise increase the risk of injury. We review sports injuries in young athletes and the long-term outcomes. Sports injuries can lead to disturbances in growth such as limb length discrepancy, caused by traumatised physeal growth induced by injury. Osgood-Schlatter lesion may also cause some sequelae such as painful ossicles in the distal patellar tendon. The apophysis can be fragmentised or separated, and this could be an adaptive change to the increased stress typical of overuse activities. These changes produce an osseous reaction even though they are not disabling. Participation in physical exercise at a young age should be encouraged, because of the health benefits, but decreasing the incidence and severity of sports injuries in young athletes is an important component of any athletic programme and may generate a long-term economic impact in health care costs. Active prevention measures are the main weapon to decrease the (re-)injury rate and to increase athletic performance.