Knee physeal stress injury and osteochondrosis in pediatric athletes: a systematic review

Epiphyseal physeal stress injuries (PSIs) and articular osteochondroses of the knee in pediatric athletes are incompletely understood. Delayed diagnosis can lead to growth arrest and osseous deformity, increasing the need for surgical correction and long-term morbidity.

A systematic review was performed using PRISMA guidelines. PubMed, Scopus, and Embase databases were searched to identify peer-reviewed publications on the occurrence, diagnosis, and outcome of epiphyseal PSIs and articular osteochondroses of the knee in skeletally immature pediatric athletes, yielding 16 articles (26 patients: 17 males and 9 females; 31 knees). Study quality, demographic data, sports activity, imaging findings, treatment, and outcomes were collected and summarized using descriptive statistics.

There is a relative paucity of data on epiphyseal PSIs and articular osteochondroses affecting the knee. Radiographs and MRI are commonly used for evaluation. Treatment typically begins with conservative management; surgical intervention is considered when conservative treatment fails or substantial growth disturbance or skeletal deformity is present.

The optimal duration of conservative treatment and the indications, timing, and type of surgical intervention remain uncertain because the available evidence is limited.

Early radiographic findings of epiphyseal PSIs or articular osteochondroses of the knee are often subtle, and MRI may be needed to clarify the diagnosis and exclude alternative diagnoses.

Surveillance across youth sports should include epiphyseal PSIs and articular osteochondroses of the knee. Prospective longitudinal epidemiological and imaging studies are needed to better characterize incidence, prevalence, natural history, and complication rates.