Sports-related injuries in children and adolescents

Sports injuries have characteristic locations and imaging patterns in pediatrics. The objective was to describe the most frequent patterns by X-ray (Rx), ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Injuries predominate in the lower limbs, at the level of cartilaginous apophyses, which constitute the areas of greatest weakness in the pediatric skeleton. Classified as acute and subacute, acute injuries occur after a sudden muscle contraction with avulsion fracture (AF), causing pain and loss of muscle function. The X-ray shows the avulsed bone fragment. The ultrasound measures the distance of the displaced fragment and identifies soft tissue alterations, being a good method since it does not involve ionizing radiation. The MRI assesses the apophyseal cartilage and bone marrow edema. Subacute or overuse injuries are due to chronic stress on the tendon insertion, causing traction apophysitis. On the X-ray, we observe cortical irregularity or apophyseal fragmentation with thickening and enlargement of the adjacent soft tissues. The ultrasound identifies thickening of the tendon in the enthesis area, loss of myofibrillar architecture, calcifications, and hypervascularization with Power Doppler. MRI is better for visualizing tendon change, soft tissue and bone marrow edema, increased cartilage volume, and cortical lesions. Knowledge of the most common sports injuries in the immature skeleton through various imaging methods is essential for accurate diagnosis and follow up.