Avulsions in adolescent soccer players: preliminary results of radiographic, ultrasonographic and magnetic resonance findings

Abstract

Objectives: The main objective of this study was to characterize soccer related avulsions radiologically. The secondary objectives were to describe the athletes' clinical profile and other musculoskeletal changes associated with avulsions. Materials and methods: Cross-sectional study with adolescent athletes from a Brazilian team soccer academy. Inclusion criteria were age between 11 and 16 years and clinical and magnetic resonance imaging (MRI) diagnosis of avulsion. Exclusion criteria were exams with an unacceptable technical standard and absence of clinical data. Four radiologists revised the exams consensually (two for each method). The equipment used was a General Electric (GE) US scanner, model Logic 10, and a 1.5 T MRI GE scanner, Optima MR 360 model, and a Shimadzu RX scanner, Radspeed MC model. Results and discussion: Nine showed signs of avulsion from a sample of 37 athletes. The mean age was 13.1 years, and all were male. Four athletes were injured during the matches (44.4%), and another five were in training (55.6%). Clinically, one injury was considered mild (11.1%), two moderate (22.2%), and six severe (66.7%). The anatomical locations and frequencies of avulsions were: five in the anterior inferior iliac spine (AIIS) (55.6%), two in the ischiatic tuberosity (IT) (22.2%), and two in the iliac crest (22.2%). Ultrasonography (US) was performed in 10 cases and detected seven avulsions (77.8%). All lesions not detected by US occurred at the IT. A pelvic radiograph was performed in seven cases and was positive in five athletes (77.8%). Undetected cases occurred at the AIIS. Avulsions occurred in isolation in eight cases (88.9%), simultaneously with indirect trauma in three (33.3%) and direct trauma in two (22.2%). Conclusion: In adolescent soccer players, a quarter of traumatic injuries are avulsions, which are more common at the AIIS. US proved ineffective in identifying some IT lesions and radiography, some others at the AIIS.