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Hip apophyseal injuries in soccer players: can MRI findings be useful to define when to return to play?

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Abstract

Objective

To describe magnetic resonance imaging (MRI) findings in professional soccer players with acute apophyseal injury of the hip and to assess their relationship with return to sports.

Material and methods

Adolescent soccer players with diagnosis of apophyseal injury in the anterosuperior and anteroinferior iliac spine were retrospectively evaluated between 2008 and 2016. All athletes underwent hip MRI examination within 4 days after onset of clinical complaint. Images were independently analyzed by two radiologists. Medical records were reviewed to obtain clinical data.

Results

Mean displacement of the apophysis was 4.8 ± 4.6 mm. Bone edema was present in 82% of athletes and muscular edema in 41%. The mean time to return to sports was 37.3 ± 14.7 days. The difference between the measurements of the two radiologists was close to zero with agreement limits below 1.0 mm (p < 0.001). There was a significant correlation between displacement of the apophysis and return to sports, as well as between both and the presence of muscular edema. A displacement of the apophysis of 3.0 mm might serve as a parameter to predict return to sports/activity before 40 days, with a sensitivity of 92% and specificity of 96%, considering conservative physiotherapy treatment.

Conclusion

Displacement of the apophysis and presence of muscular edema evaluated by MRI showed a significant correlation with return to sports in athletes with acute apophyseal injuries of the anterosuperior and anteroinferior iliac spines.

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Abbreviations

AIIS:

Anteroinferior iliac spine

ASIS:

Anterosuperior iliac spine

AUC:

Area under the curve

CI:

Confidence intervals

FIFA:

International Federation of Association Football (soccer)

FOV:

Field of view

LLoA:

Lower limit of agreement

MRI:

Magnetic resonance imaging

PD:

Proton density

SD:

Standard deviation

TR:

Repetition time

TE:

Echo time

UEFA:

Union of European Football Associations

ULoA:

Upper limit of agreement

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Authors and Affiliations

  1. Department of Radiology and Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Napoleão de Barros, 800, São Paulo, SP, 04024-002, Brazil

    Andre Fukunishi Yamada, Andrea Puchnick, Frederico Roberto Pollack Filho, Erica Narahashi & Artur da Rocha Correa Fernandes

  2. Department of Radiology, Hospital do Coração – HCor and Teleimagem, Rua Desembargador Eliseu Guilherme, 53, 7th Floor, São Paulo, 04004-030, Brazil

    Andre Fukunishi Yamada

  3. ALTA Diagnostic Center (DASA Group), São Paulo, Brazil

    Andre Fukunishi Yamada

  4. Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Napoleão de Barros, 715, 1st Floor, São Paulo, 04024-002, Brazil

    Gustavo Gonçalves Arliani & Alberto de Castro Pochini

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  1. Andre Fukunishi Yamada
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Correspondence to Andre Fukunishi Yamada.

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Yamada, A.F., Puchnick, A., Filho, F.R.P. et al. Hip apophyseal injuries in soccer players: can MRI findings be useful to define when to return to play?. Skeletal Radiol 50, 2273–2280 (2021). https://doi.org/10.1007/s00256-021-03797-6

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  • DOI: https://doi.org/10.1007/s00256-021-03797-6

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