Long-term outcome of conservatively treated lower limb apophyseal injuries in children and adolescents: A systematic review

Abstract

Apophyseal injuries are generally believed to run a self-limiting course, suggesting conservative treatment is indicated. We summarized the long-term consequences of lower limb apophyseal injuries after conservative treatment. We conducted a systematic review using the Cochrane methodology, and reported findings according to PRISMA. MEDLINE, EMBASE, Cochrane CENTRAL, PEDro, and SPORTDiscus were searched. Studies had to include participants aged 8-18 years old, with a clinical diagnosis of apophyseal injury in the lower limb, more specifically Sever's disease, Osgood-Schlatter disease, or Sinding-Larsen-Johansson disease, non-surgically treated, with a minimum follow-up time of 1 year, and with at least one of the following outcome measures: pain, secondary structural changes, functional outcome, participation in sports, and recurrent or subsequent injury. PROSPERO registration number: CRD42020146412. Twelve studies on Osgood-Schlatter disease, three studies on Sever's disease, and no studies on Sinding-Larsen-Johansson disease met inclusion criteria. Results of studies varied widely. Important limitations were heterogeneity between studies and lack of high-quality research studies. Apophyseal injuries do not always appear to be self-limiting, with some patients experiencing pain, secondary structural changes, a worse functional outcome, and difficulty resuming sports after more than 1 year of follow-up.