Comparison study of growth plate fusion using MRI versus plain radiographs as used in age determination for exclusion of overaged football players

Background

MRI of distal radius fusion is currently being used in the U17 World Cup to exclude overaged players. Developing countries that cannot afford to perform MRI on their players are using plain radiographs based on the same MRI criteria of fusion.

Objective

The aim of this study is to compare the grade of fusion of the left wrist distal radial growth plate between MRI and plain radiographs.

Methods

150 healthy male football players were grouped into five age groups ranging from 15 to 19 years old. Each participant had coronal T1-weighted MRI and plain radiograph of the left wrist. The degree of distal radius fusion was rated randomly by three radiologists using a six-stage grading system proposed by the FIFA Research Centre.

Results

MRI assessment of distal radial growth plate fusion has good correlation with plain radiograph fusion (r=0.949). The mean of x-ray grading is higher than the MRI grading in the 15, 16, 17, 18 and 19 years old age groups with p=0.443, 0.001, 0.009, <0.001 and 0.003, respectively, using Wilcoxon signed ranked test. Intraobserver and interobserver correlations were high (r=0.9). T1 MRI correlation with chronological age (r=0.771) was close to plain radiographs (r=0.821) with p value of <0.001.

Conclusion

This article is of major importance as it is the first to show that x-rays significantly overrate the grading of fusion in this age group and therefore should not be used to exclude overaged players as is occurring now to the distress of many genuinely eligible players.