Fact-sheet: Iliac crest osteochondrosis - apophysitis
Updated on 09/17/2021 at 12:16 PM
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Definition
-Apophysis: physiological bony prominence, insertion site for tendons or ligaments
- Secondary ossification centers composed of cartilage and connected to bone by the physis
- Apophysis initially cartilaginous then progressive ossification starting at 10-15 years and maturation at 20-25 years
- Secondary ossification center of the iliac crest appears between 14 and 16 years
- Pathology of tendon insertions
-Children, adolescents, young adults with apophyseal maturation:
Ligaments and tendons stronger than bone
Muscle mass and strength increase more rapidly than cartilage resistance
Apophyseal avulsion fracture, acute or chronic apophysitis at the tendon insertion site
In Adults
-Bone stronger than ligaments and tendons
Tendinous strain with very high level of muscular activity in intensity and duration
ACUTE LESIONS:
During sports activity with sudden pain and functional impairment
Approach: X-ray ++, sometimes ultrasound/MRI.
Generally heals without sequelae with complete cessation of activity and symptomatic treatment.
Healing is achieved in 6 to 12 weeks with normal return to sport.
CHRONIC LESIONS:
Micro-trauma with repeated tension from intense muscular contractions, over a long period.
Sometimes an initial painful episode not investigated or wrongly considered a muscular injury with management by early active rehabilitation. Results are poor with inability to resume sports activity.
Pain, functional impairment, sometimes radiculalgia with in all cases decreased performance or total inability to practice sport.
X-ray ++: more or less aggressive ossified lesions that may suggest a tumoral process.
>non-immobilized fracture with hypertrophic callus responsible for hypertrophic heterotopic ossification.
CT: hypertrophic ossification
MRI: associated muscular, tendinous, or ligamentous lesions
CAUTION Active ossification phase with edema may show extensive hyperintensity that may reinforce the hypothesis of a tumor. If biopsy is performed, an inexperienced pathologist may, faced with this hypercellularity, make a false diagnosis of osteosarcoma.
Prognosis less favorable than acute lesions, persistent pain preventing return to sport or return to good level, often with sequelae and complications in adulthood
Iliac crest avulsions
- Insertion site of abdominal muscles, external and internal obliques, transversus
- Complete avulsion is rare and occurs acutely with sudden change of direction while running or subacutely in marathon runners
- Acute avulsions: soccer players, tennis players and gymnasts
spontaneous and provoked pain along the iliac crest.
