Published Ahead of Print

Time to time, I like to share with readers of this blog some of the features of CJSM with which they may not be familiar.  Our journal’s website has a wealth of resources that I’d encourage you to check out regularly.

For instance, besides publishing the full journal every two months, we frequently disseminate breaking sports medicine research in a more fluid, continuous fashion via our “Published Ahead of Print” (PAP) feature.  PAP allows us to pursue a major goal we editors have:  to contribute to the world of clinical sports medicine in a contemporary fashion, taking advantage of the multi-media offerings of the digital world.   This goal is reflected in this blog itself; in the podcast feature we have just begun; in our engagement with you on social media; and in the journal’s iPad functionality.

“When you want it….where you want it…the way you want it.”  That’s the motto.

And so, today I wanted to share with you a ‘Practical Management’ research article that was just published via PAP:  “Surgical Management of Traumatic Avulsion of the Ischial Tuberosity in Young Athletes,‘ by Roland M. Biedert, MD.

It is one of the many interesting, hot-off-the-press articles you’ll find in the CJSM PAP collection.

I was particularly interested in this article, as I see many adolescent athletes and pelvic apophyseal injuries arrive at our clinic in droves.  It is rather uncommon to see an acute, purely tendionous injury in my clinic population:  last week when I saw an acute rupture of the proximal long head of the biceps tendon, in a 17-year-old pole vaulter, I was intrigued indeed!  The acute achilles tendon rupture in my clinic makes me wonder whether a fluoroquinolone has been used recently; seeing a patient in my own age group, I’d more likely say, c’est la vie…..

An ischial tuberosity avulsion injury which can be managed conservatively.

The more common story in my day-to-day clinical world is for a chronic or acute injury to the apophyseal cartilage, to which a muscle-tendon unit attaches.  The tendon holds, I tell a patient; it is its attachment to the growth cartilage that gives way.

The litany:  Sever’s, Osgood-Schlatter’s, Little Leaguer’s Elbow, and the multiple pelvic apophyseal injuries (apparently undeserving of an eponym) we will see frequently.

Rarely will they need surgical management, though the healing and time to return to sport can be  prolonged.  The pain of iliac crest apophyseal avulsions or simple apophysites can hang around like a bad smell in a room, I tell my patients.

I typically will contact a surgical colleague for a possible consultation if the displacement of the osseous fragment in a pelvic injury is greater than 2 cm, a factoid that Dr. Biedert confirms as a possible surgical indication in his article.  For ischial tuberosity apophyseal injuries specifically, he gives a thorough description of the injury’s epidemiology and that consideration may also be given to secondary surgical treatment for a poorly united fragment, or one in which the significant bone remodelling that can be seen causes pain with sitting, or compression of the sciatic nerve.

What I found especially interesting in the three case reports is the thorough description of the postoperative recovery, and a very thorough description of the rehabilitation protocol the author uses.  I would suspect that a modified version of this could be used for conservative management as well; I’ll forward this article on to my physical therapy colleagues for sure.

You can be alerted to the CJSM PAP and more by subscribing to our ‘electronic Table of Contents’ (eTOC) here.  Be sure to do that!