Triradiate cartilage injury

A 13-year-old football player presented with a nine-month history of recurrent groin pain. His symptoms were made worse by running and football training and were improved with rest. At the initial presentation, the patient was diagnosed with left Anterior Inferior Iliac Spine (AIIS) apophysitis based on his clinical examination (no MRI was performed). As his symptoms did not completely disappear, the patient returned for review. While the patient continued to report pain overt the left AIIS, his active hip flexion and the active (SLR) tests were normal. In order to further evaluate pathology a MR scan was requested.

The MR imaging shows bone oedema surrounding the triradiate cartilage consistent with triradiate cartilage stress reaction. The remainder of the hip and groin appear unremarkable.

The MRI findings were discuss with the player and with his family. They were reassured that this problem would likely resolve with time. With further rest and rehabilitation the patient was able to return to football and other sport.

The triradiate cartilage a Y- shaped epiphyseal plate at the junction of the ischium, ilium, and pubis in the skeletally immature skeleton.

The vertical component of the “Y” is formed by the meeting of the ischium and pubis, the anterior arm is the junction of the ilium and pubis and the posterior arm is the junction of the ilium and ischium. It is a ‘non-articulating’ structure and constitutes approximately 30% of the acetabular cartilage complex. Closure of the triradiate cartilage occurs in mid-adolescence (approximately 15-16 years in males and 13-14 years in females).

Injuries to the triradiate cartilage are rare and as a result there is little evidence to guide treatment decisions. The current literature supports non-operative management in most cases. This generally improves with a period or rest and avoidance of pain provoking activities. Surgical management is reserved for severely displaced fractures and for when there is evidence of instability. It is however important to recognise that these recommendations are based on a small number of cases studies and case reports.

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