Abstract
BackgroundOveruse injuries are reported to be more common than acute trauma in children and adolescents, causing pain and reduced function. The most common is apophysitis - a traction injury to the apophysis in growing individuals. The duration of symptoms reported in the literature is between 6 weeks to 6 months or more. The objective of this systematic review and network meta-analysis is to compare the effectiveness and safety of all available treatments for any type of apophysitis in children and adolescents.Methods/DesignWe will conduct a systematic review to retrieve all relevant studies applying a comparative design. Searches will be made in the Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL and SportDiscus databases and via reference searching. The efficacy of treatments will be compared with respect to the outcomes 1) time to pain-free activity and 2) risk of subsequent injury. Risk of bias assessment will be made using revised tool for assessing risk of bias in randomized trials for Randomized trials and Robins-I tool for non-randomized trials. We will explore if different treatment comparisons are sufficiently similar in terms of effect modifiers (transitivity assumption) with the aim to conduct network meta-analyses for randomized and non-randomized studies separately. A treatment hierarchy will be obtained using the surface under the cumulative ranking curve (SUCRA) and mean ranks, visualized using rankograms. We will use the CINeMA software to apply the modified version of Grades of Recommendation, Assessment, Development and Evaluation (GRADE), developed specifically to evaluate the quality of evidence in network meta-analysis.DiscussionTo date the comparative effects of interventions for apophysitis seem to rely mainly on expert opinion. We aim to identify all comparative treatment designs described in the literature and synthesize data when possible. We will use the estimated treatment effects between injury locations to provide guidance in managing apophysitis.Trial registrationPROSPERO ID number: CRD42018083746.
Highlights
Overuse injuries are reported to be more common than acute trauma in children and adolescents, causing pain and reduced function
We aim to identify all comparative treatment designs described in the literature and synthesize data when possible
Overuse injuries are reported to be more common than acute trauma in children and adolescent, causing pain and reduced function [1]
Summary
Overuse injuries are reported to be more common than acute trauma in children and adolescents, causing pain and reduced function. Overuse injuries are reported to be more common than acute trauma in children and adolescent, causing pain and reduced function [1]. In this population the most frequent overuse injuries are apophysitis, a traction injury to the apophysis with common names such as Osgood-Schlatters disease, Sever’s disease, and Pitchers elbow [2]. The apophysis consists of three chondrocyte zones: The resting germinal or stem cells represent the reserve zone, which is located adjacent to the apophysis It consists of irregularly stacked chondrocytes and demonstrates a low rate of proliferation. Apophyseal stresses in overuse injuries have several potential sequelae including physeal widening, early calcification, avulsion fractures, and premature closure [5]
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