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Dadoo S, Herman ZJ, Hughes JD. Surgical Techniques in Primary ACL Reconstruction: Getting It Right the First Time. Clin Sports Med 2024; 43:399-412. [PMID: 38811118 DOI: 10.1016/j.csm.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
The ideal anterior cruciate ligament reconstruction (ACLR) is an individualized anatomic approach aimed at restoring the native structure and function of the knee. Surgeons are tasked with difficult decisions during operative planning, including the optimal graft choice for the patient and appropriate anatomic tunnel placement. Special considerations should additionally be given for skeletally immature patients and those at high-risk for failure, including younger, active patients participating in pivoting sports. The purpose of this review is to provide an overview of the individualized approach to ACLR, including the necessary preoperative and operative considerations to optimize patient outcomes.
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Affiliation(s)
- Sahil Dadoo
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA.
| | - Zachary J Herman
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Pruneski JA, Tavabi N, Heyworth BE, Kocher MS, Kramer DE, Christino MA, Milewski MD, Yen YM, Micheli L, Murray MM, Garcia Andujar RA, Kiapour AM. Prevalence and Predictors of Concomitant Meniscal Surgery During Pediatric and Adolescent ACL Reconstruction: Analysis of 4729 Patients Over 20 Years at a Tertiary-Care Regional Children's Hospital. Orthop J Sports Med 2024; 12:23259671241236496. [PMID: 38515604 PMCID: PMC10956158 DOI: 10.1177/23259671241236496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/11/2023] [Indexed: 03/23/2024] Open
Abstract
Background The rate of concomitant meniscal procedures performed in conjunction with anterior cruciate ligament (ACL) reconstruction is increasing. Few studies have examined these procedures in high-risk pediatric cohorts. Hypotheses That (1) the rates of meniscal repair compared with meniscectomy would increase throughout the study period and (2) patient-related factors would be able to predict the type of meniscal operation, which would differ according to age. Study Design Cohort study (prevalence); Level of evidence, 2. Methods Natural language processing was used to extract clinical variables from notes of patients who underwent ACL reconstruction between 2000 and 2020 at a single institution. Patients were stratified to pediatric (5-13 years) and adolescent (14-19 years) cohorts. Linear regression was used to evaluate changes in the prevalence of concomitant meniscal surgery during the study period. Logistic regression was used to determine predictors of the need for and type of meniscal procedure. Results Of 4729 patients (mean age, 16 ± 2 years; 54.7% female) identified, 2458 patients (52%) underwent concomitant meniscal procedures (55% repair rate). The prevalence of lateral meniscal (LM) procedures increased in both pediatric and adolescent cohorts, whereas the prevalence of medial meniscal (MM) repair increased in the adolescent cohort (P = .02). In the adolescent cohort, older age was predictive of concomitant medial meniscectomy (P = .031). In the pediatric cohort, female sex was predictive of concomitant MM surgery and of undergoing lateral meniscectomy versus repair (P≤ .029). Female sex was associated with decreased odds of concomitant LM surgery in both cohorts (P≤ .018). Revision ACLR was predictive of concomitant MM surgery and of meniscectomy (medial and lateral) in the adolescent cohort (P < .001). Higher body mass index was associated with increased odds of undergoing medial meniscectomy versus repair in the pediatric cohort (P = .03). Conclusion More than half of the young patients who underwent ACLR had meniscal pathology warranting surgical intervention. The prevalence of MM repair compared with meniscectomy in adolescents increased throughout the study period. Patients who underwent revision ACLR were more likely to undergo concomitant meniscal surgeries, which were more often meniscectomy. Female sex had mixed effects in both the pediatric and adolescent cohorts.
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Affiliation(s)
- James A. Pruneski
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nazgol Tavabi
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Benton E. Heyworth
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mininder S. Kocher
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dennis E. Kramer
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa A. Christino
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew D. Milewski
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yi-Meng Yen
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lyle Micheli
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Martha M. Murray
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rafael A. Garcia Andujar
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ata M. Kiapour
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Chen KJ, Mysore A, Furdock RJ, Sattar A, Sinkler MA, Glotzbecker MP, Liu RW. Correlations Between Eight Comprehensive Skeletal Maturity Systems in a Modern Peripubertal Pediatric Population. J Pediatr Orthop 2024; 44:e51-e56. [PMID: 37767780 DOI: 10.1097/bpo.0000000000002533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND Several skeletal maturity systems allow for accurate skeletal age assessment from a wide variety of joints. However, discrepancies in estimates have been noted when applying systems concurrently. The aims of our study were to (1) compare the agreement among 8 different skeletal maturity systems in modern pediatric patients and (2) compare these discrepancy trends qbetween modern and historic children. METHODS We performed a retrospective (January 2000 to May 2022) query of our picture archiving and communication systems and included peripubertal patients who had at least two radiographs of different anatomic regions obtained ≤3 months apart for 8 systems: (1) proximal humerus ossification system (PHOS), (2) olecranon apophysis ossification staging system (OAOSS), (3) lateral elbow system, (4) modified Fels wrist system, (5) Sanders Hand Classification, (6) optimized oxford hip system, (7) modified Fels knee system, and (8) calcaneal apophysis ossification staging system (CAOSS). Any abnormal (ie, evidence of fracture or congenital deformity) or low-quality radiographs were excluded. These were compared with a cohort from a historic longitudinal study. SEM skeletal age, representing the variance of skeletal age estimates, was calculated for each system and used to compare system precision. RESULTS A total of 700 radiographs from 350 modern patients and 954 radiographs from 66 historic patients were evaluated. In the modern cohort, the greatest variance was seen in PHOS (SEM: 0.28 y), Sanders Hand (0.26 y), and CAOSS (0.25 y). The modified Fels knee system demonstrated the smallest variance (0.20 y). For historic children, the PHOS, OAOSS, and CAOSS were the least precise (0.20 y for all). All other systems performed similarly in historic children with lower SEMs (range: 0.18 to 0.19 y). The lateral elbow system was more precise than the OAOSS in both cohorts. CONCLUSIONS The precision of skeletal maturity systems varies across anatomic regions. Staged, single-parameter systems (eg, PHOS, Sanders Hand, OAOSS, and CAOSS) may correlate less with other systems than those with more parameters. LEVEL OF EVIDENCE Level III-retrospective study.
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Affiliation(s)
- Kallie J Chen
- Department of Orthopaedics, University Hospital Cleveland Medical Center
| | - Amog Mysore
- Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine
| | - Ryan J Furdock
- Department of Orthopaedics, University Hospital Cleveland Medical Center
| | - Abdus Sattar
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - Margaret A Sinkler
- Department of Orthopaedics, University Hospital Cleveland Medical Center
| | - Michael P Glotzbecker
- Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine
| | - Raymond W Liu
- Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine
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Kim PH, Yoon HM, Kim JR, Hwang JY, Choi JH, Hwang J, Lee J, Sung J, Jung KH, Bae B, Jung AY, Cho YA, Shim WH, Bak B, Lee JS. Bone Age Assessment Using Artificial Intelligence in Korean Pediatric Population: A Comparison of Deep-Learning Models Trained With Healthy Chronological and Greulich-Pyle Ages as Labels. Korean J Radiol 2023; 24:1151-1163. [PMID: 37899524 PMCID: PMC10613838 DOI: 10.3348/kjr.2023.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/01/2023] [Accepted: 08/06/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE To develop a deep-learning-based bone age prediction model optimized for Korean children and adolescents and evaluate its feasibility by comparing it with a Greulich-Pyle-based deep-learning model. MATERIALS AND METHODS A convolutional neural network was trained to predict age according to the bone development shown on a hand radiograph (bone age) using 21036 hand radiographs of Korean children and adolescents without known bone development-affecting diseases/conditions obtained between 1998 and 2019 (median age [interquartile range {IQR}], 9 [7-12] years; male:female, 11794:9242) and their chronological ages as labels (Korean model). We constructed 2 separate external datasets consisting of Korean children and adolescents with healthy bone development (Institution 1: n = 343; median age [IQR], 10 [4-15] years; male: female, 183:160; Institution 2: n = 321; median age [IQR], 9 [5-14] years; male: female, 164:157) to test the model performance. The mean absolute error (MAE), root mean square error (RMSE), and proportions of bone age predictions within 6, 12, 18, and 24 months of the reference age (chronological age) were compared between the Korean model and a commercial model (VUNO Med-BoneAge version 1.1; VUNO) trained with Greulich-Pyle-based age as the label (GP-based model). RESULTS Compared with the GP-based model, the Korean model showed a lower RMSE (11.2 vs. 13.8 months; P = 0.004) and MAE (8.2 vs. 10.5 months; P = 0.002), a higher proportion of bone age predictions within 18 months of chronological age (88.3% vs. 82.2%; P = 0.031) for Institution 1, and a lower MAE (9.5 vs. 11.0 months; P = 0.022) and higher proportion of bone age predictions within 6 months (44.5% vs. 36.4%; P = 0.044) for Institution 2. CONCLUSION The Korean model trained using the chronological ages of Korean children and adolescents without known bone development-affecting diseases/conditions as labels performed better in bone age assessment than the GP-based model in the Korean pediatric population. Further validation is required to confirm its accuracy.
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Affiliation(s)
- Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Jeong Rye Kim
- Department of Radiology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Jae-Yeon Hwang
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Jin-Ho Choi
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jisun Hwang
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | | | | | | | | | - Ah Young Jung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Ah Cho
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo Hyun Shim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Boram Bak
- University of Ulsan Foundation for Industry Cooperation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Seong Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Poutre AJ, Meyers AB. Imaging the pediatric anterior cruciate ligament: not little adults. Pediatr Radiol 2023; 53:1587-1599. [PMID: 36856757 DOI: 10.1007/s00247-023-05608-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/11/2023] [Accepted: 01/15/2023] [Indexed: 03/02/2023]
Abstract
An increased incidence of anterior cruciate ligament (ACL) injuries in children over the last few decades has led to a corresponding increase in ACL reconstruction procedures in children. In this review, we will illustrate unique features seen when imaging the ACL in children versus adults. After briefly reviewing relevant normal ACL anatomy, we will review imaging findings of congenital ACL dysplasia. This is followed by a discussion of imaging ACL avulsions. Lastly, we will review the different types of ACL reconstruction procedures performed in skeletally immature children and their post-operative appearances.
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Affiliation(s)
- Augustah J Poutre
- Department of Radiology, Brooke Army Medical Center, San Antonio, TX, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, ML 5031, Cincinnati, OH, 45229, USA
| | - Arthur B Meyers
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, ML 5031, Cincinnati, OH, 45229, USA.
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Braga SR, Santili C, Rodrigues NVM, Soni JF, Green DW. Growth modulation for angular knee deformities: a practical guideline. Curr Opin Pediatr 2023; 35:110-117. [PMID: 36218192 DOI: 10.1097/mop.0000000000001183] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW This study aimed to review the established concepts and advances related to growth modulation for treating knee angular deformities. Although they are considered well tolerated procedures, careful indications and accurate techniques are necessary to ensure good results. RECENT FINDINGS In addition to general clinical and radiographic evaluations, new tools such as two-dimensional low-dose radiography and gait analysis have been used to clarify angular and torsional combinations and the impact of mild angulations on the knee joint. Temporary epiphysiodesis is commonly the choice, and it can be performed with different implants such as staples, tension band plates (TBP), percutaneous transphyseal screws (PETS), sutures, and screws. SUMMARY Considering its principles, TBP has been preferred for younger children. Cost can be a limitation, and research for alternative implants such as screws and nonabsorbable sutures indicate they might be an alternative in the future. In adolescents, PETS becomes an attractive alternative; however, its reversible character has been controversial, and further studies are needed to establish limits in younger patients.
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Affiliation(s)
- Susana Reis Braga
- Santa Casa de Misericórdia de São Paulo
- Hospital Israelita Albert Einstein
| | - Claudio Santili
- Santa Casa de Misericórdia de São Paulo
- Hospital Israelita Albert Einstein
| | | | - Jamil F Soni
- Pontifícia Universidade Católica do Paraná
- Hospital do Trabalhador, Curitiba, Paraná, PR, Brazil
| | - Daniel W Green
- Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Serra G, Antona V, Di Pace MR, Giuffrè M, Morgante G, Piro E, Pirrello R, Salerno S, Schierz IAM, Verde V, Corsello G. Intestinal malrotation in a female newborn affected by Osteopathia Striata with Cranial Sclerosis due to a de novo heterozygous nonsense mutation of the AMER1 gene. Ital J Pediatr 2022; 48:206. [PMID: 36581928 PMCID: PMC9801547 DOI: 10.1186/s13052-022-01403-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/22/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Osteopathia Striata with Cranial Sclerosis (OS-CS), also known as Horan-Beighton Syndrome, is a rare genetic disease; about 90 cases have been reported to date. It is associated with mutations (heterozygous for female subjects and hemizygous for males) of the AMER1 gene, located at Xq11.2, and shows an X-linked pattern of transmission. Typical clinical manifestations include macrocephaly, characteristic facial features (frontal bossing, epicanthal folds, hypertelorism, depressed nasal bridge, orofacial cleft, prominent jaw), hearing loss and developmental delay. Males usually present a more severe phenotype than females and rarely survive. Diagnostic suspicion is based on clinical signs, radiographic findings of cranial and long bones sclerosis and metaphyseal striations, subsequent genetic testing may confirm it. CASE PRESENTATION Hereby, we report on a female newborn with frontal and parietal bossing, narrow bitemporal diameter, dysplastic, low-set and posteriorly rotated ears, microretrognathia, cleft palate, and rhizomelic shortening of lower limbs. Postnatally, she manifested feeding intolerance with biliary vomiting and abdominal distension. Therefore, in the suspicion of bowel obstruction, she underwent surgery, which evidenced and corrected an intestinal malrotation. Limbs X-ray and skull computed tomography investigations did not show cranial sclerosis and/or metaphyseal striations. Array-CGH analysis revealed normal findings. Then, a target next generation sequencing (NGS) analysis, including the genes involved in skeletal dysplasias, was performed and revealed a de novo heterozygous nonsense mutation of the AMER1 gene. The patient was discharged at 2 months of age and included in a multidisciplinary follow-up. Aged 9 months, she now shows developmental and growth (except for relative macrocephaly) delay. The surgical correction of cleft palate has been planned. CONCLUSIONS Our report shows the uncommon association of intestinal malrotation in a female newborn with OS-CS. It highlights that neonatologists have to consider such a diagnosis, even in absence of cranial sclerosis and long bones striations, as these usually appear over time. Other syndromes with cranial malformations and skeletal dysplasia must be included in the differential diagnosis. The phenotypic spectrum is wide and variable in both genders. Due to variable X-inactivation, females may also show a severe and early-onset clinical picture. Multidisciplinary management and careful, early and long-term follow-up should be offered to these patients, in order to promptly identify any associated morbidities and prevent possible complications or adverse outcomes.
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Affiliation(s)
- Gregorio Serra
- grid.10776.370000 0004 1762 5517Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Vincenzo Antona
- grid.10776.370000 0004 1762 5517Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Maria Rita Di Pace
- grid.10776.370000 0004 1762 5517Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Mario Giuffrè
- grid.10776.370000 0004 1762 5517Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Giusy Morgante
- grid.10776.370000 0004 1762 5517Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Ettore Piro
- grid.10776.370000 0004 1762 5517Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Roberto Pirrello
- grid.10776.370000 0004 1762 5517Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Sergio Salerno
- grid.10776.370000 0004 1762 5517Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Ingrid Anne Mandy Schierz
- grid.10776.370000 0004 1762 5517Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Vincenzo Verde
- grid.10776.370000 0004 1762 5517Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Giovanni Corsello
- grid.10776.370000 0004 1762 5517Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Palermo, Italy
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Jamshidi K, Bagherifard A, Mirzaei A. A comparison of osteoarticular allografts and allograft-prosthesis composites for reconstruction of the distal femur after resection of a bone tumour in childhood : a retrospective study. Bone Joint J 2022; 104-B:1174-1179. [PMID: 36177642 DOI: 10.1302/0301-620x.104b10.bjj-2022-0235.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Osteoarticular reconstruction of the distal femur in childhood has the advantage of preserving the tibial physis. However, due to the small size of the distal femur, matching the host bone with an osteoarticular allograft is challenging. In this study, we compared the outcomes and complications of a resurfaced allograft-prosthesis composite (rAPC) with those of an osteoarticular allograft to reconstruct the distal femur in children. METHODS A retrospective analysis of 33 skeletally immature children with a malignant tumour of the distal femur, who underwent resection and reconstruction with a rAPC (n = 15) or osteoarticular allograft (n = 18), was conducted. The median age of the patients was ten years (interquartile range (IQR) 9 to 11) in the osteoarticular allograft group and nine years (IQR 8 to 10) in the rAPC group (p = 0.781). The median follow-up of the patients was seven years (IQR 4 to 8) in the osteoarticular allograft group and six years (IQR 3 to 7) in the rAPC group (p = 0.483). Limb function was evaluated using the Musculoskeletal Tumor Society (MSTS) score. RESULTS At final follow-up, the knee was unstable in 9/18 patients (50%) in the osteoarticular allograft group and 2/15 patients (13%) in the rAPC group (p = 0.026). The median range of motion (ROM) of the knee was 117° (IQR 115° to 120°) in the osteoarticular allograft group and 100° (IQR 95° to 105°) in the rAPC group (p < 0.001). The median MSTS score was 25 (IQR 23 to 26) in the osteoarticular allograft group and 28 (IQR 26 to 29) in the rAPC group (p = 0.007). Osteoarthritic change was detected in 11/18 patients (61%) in the osteoarticular allograft group and in 4/15 (26%) patients in the rAPC group (p = 0.048). CONCLUSION In our series, a resurfaced allograft-prosthesis composite provided better knee stability and function, with a lower rate of osteoarthritis; an osteoarticular allograft was associated with better knee ROM.Cite this article: Bone Joint J 2022;104-B(10):1174-1179.
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Affiliation(s)
- Khodamorad Jamshidi
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bagherifard
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Laufer A, Toporowski G, Gosheger G, von der Heiden A, Rölfing JD, Frommer A, Rachbauer A, Antfang C, Rödl R, Vogt B. Preliminary results of two novel devices for epiphysiodesis in the reduction of excessive predicted final height in tall stature. J Orthop Traumatol 2022; 23:46. [PMID: 36114882 PMCID: PMC9482560 DOI: 10.1186/s10195-022-00666-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the treatment of tall stature, the reduction of excessive predicted final height can either be achieved by hormonal treatment or surgically by temporary (tED) or permanent (pED) epiphysiodesis. The present study evaluates the preliminary results of two novel devices for tED and pED around the knee to reduce the predicted final height. MATERIALS AND METHODS A retrospective analysis was performed to evaluate the clinical and radiographic outcome after bilateral epiphysiodesis for the treatment of tall stature. A cohort of 34 patients (16 girls, 18 boys) who underwent either tED or pED between 2015 and 2020 were eligible for analysis based on the electronic patient records and picture archiving and communication system of our orthopaedic teaching hospital. tED was conducted in 11 patients (32%) through bilateral implantation of four RigidTacks™ (Merete, Berlin, Germany) around the knee. Twenty-three patients (68%) received pED, performed with an EpiStop™ trephine (Eberle, Wurmberg, Germany). The mean overall follow-up time was 2.9 years. RESULTS The mean age at surgery was 12.3 years in girls and 13.2 years in boys. Patients had a mean body height of 175.2 cm in girls and 184.7 cm in boys at surgery. The mean predicted final height was 191.4 cm in girls and 210.4 cm in boys. At the last follow-up, 26 patients (76.5%) had achieved skeletal maturity. The mean height of skeletally mature patients was 187.2 cm in girls and 198.5 cm in boys. A mean reduction of the predicted final height of 5.9 cm in girls and 8.7 cm in boys was achieved, corresponding to a reduction in remaining growth of 46% in girls and 38% in boys. Secondary frontal plane deformities of the knee were detected in 5/11 patients (45.5%) in the tED group and 1/23 treatments (4.3%) in the pED group. CONCLUSIONS tED and pED have both proven to be efficient at achieving growth inhibition to reduce excessive predicted height. However, tED has been associated with an increased risk of secondary angular deformities of the knee. Furthermore, the risk of implant-related complications and the necessity of a subsequent surgical intervention for implant removal have led our study group to abandon tED when treating tall stature. Long-term results of both procedures are pending. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Andrea Laufer
- Children’s Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital of Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
- General Orthopaedics and Tumour Orthopaedics, University Hospital of Muenster, Muenster, Germany
| | - Gregor Toporowski
- Children’s Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital of Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
- General Orthopaedics and Tumour Orthopaedics, University Hospital of Muenster, Muenster, Germany
| | - Georg Gosheger
- General Orthopaedics and Tumour Orthopaedics, University Hospital of Muenster, Muenster, Germany
| | - Ava von der Heiden
- Children’s Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital of Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Jan Duedal Rölfing
- Children’s Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital of Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
- Children’s Orthopaedics and Reconstruction, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
| | - Adrien Frommer
- Children’s Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital of Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
- General Orthopaedics and Tumour Orthopaedics, University Hospital of Muenster, Muenster, Germany
| | - Anna Rachbauer
- Children’s Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital of Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
- General Orthopaedics and Tumour Orthopaedics, University Hospital of Muenster, Muenster, Germany
| | - Carina Antfang
- Children’s Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital of Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
- General Orthopaedics and Tumour Orthopaedics, University Hospital of Muenster, Muenster, Germany
| | - Robert Rödl
- Children’s Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital of Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Bjoern Vogt
- Children’s Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital of Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
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10
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Nester JR, Torino D, Sylvestre D, Young A, Ney SM, Fernandez MM, Cruz AI, Seeley MA. Risk of reoperation after primary anterior cruciate ligament reconstruction in children and adolescents. J Orthop Surg (Hong Kong) 2022; 30:10225536221122340. [PMID: 36031851 DOI: 10.1177/10225536221122340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVE To examine the incidence and risk factors of any-cause reoperation after primary ACLR in children and adolescents. DESIGN Retrospective Cohort. SETTING Electronic medical records from a large tertiary care, single institution integrated healthcare delivery system. PATIENTS Patients were under the age of 18 years and had anterior cruciate ligament reconstruction. They were excluded if they had a multi-ligamentous knee injury or <1 year follow-up. INTERVENTIONS Patients were further identified to have undergone a subsequent knee operation ipsilaterally or contralateral ACLR. MAIN OUTCOME MEASURES The rate of any-cause reoperation was our primary outcome measure. RESULTS The median age was 16. There were 208 females (53.9%) and 178 males (46.1%) included. The median follow-up was 25 months with a minimum of 12 months (interquartile range: 16.0, 46.0). The rate of any-cause reoperation was 34.7%. There was no statistically significant difference between those who underwent reoperation versus those who did not undergo reoperation relative to age, sex, BMI, graft type, or the presence of concomitant meniscal injury. The rates of ipsilateral ACLR and contralateral ACLR at any time during the study period was 8.0% and 10.9% respectively. There was no statistically significant difference for rate of reoperation between graft types, between various concomitant injuries, between those who underwent meniscus repair or no repair. CONCLUSIONS This study reflects a 34.7% rate of a subsequent knee operation after ACLR in patients younger than 18 years. These findings can be used to inform pediatric patients undergoing primary ACLR on their risk of returning to the operating room.
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Affiliation(s)
- Jordan R Nester
- 2780GeisingerMedical Center, Danville, PA, USA.,159303Janet Weis Children's Hospital, Danville, PA, USA
| | - Daniel Torino
- 2780GeisingerMedical Center, Danville, PA, USA.,159303Janet Weis Children's Hospital, Danville, PA, USA
| | | | | | | | - Meagan M Fernandez
- 2780GeisingerMedical Center, Danville, PA, USA.,159303Janet Weis Children's Hospital, Danville, PA, USA
| | - Aristides I Cruz
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Hasbro Children's Hospital, Providence, RI, USA
| | - Mark A Seeley
- 2780GeisingerMedical Center, Danville, PA, USA.,159303Janet Weis Children's Hospital, Danville, PA, USA
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11
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Hwang J, Yoon HM, Hwang JY, Kim PH, Bak B, Bae BU, Sung J, Kim HJ, Jung AY, Cho YA, Lee JS. Re-Assessment of Applicability of Greulich and Pyle-Based Bone Age to Korean Children Using Manual and Deep Learning-Based Automated Method. Yonsei Med J 2022; 63:683-691. [PMID: 35748080 PMCID: PMC9226834 DOI: 10.3349/ymj.2022.63.7.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate the applicability of Greulich-Pyle (GP) standards to bone age (BA) assessment in healthy Korean children using manual and deep learning-based methods. MATERIALS AND METHODS We collected 485 hand radiographs of healthy children aged 2-17 years (262 boys) between 2008 and 2017. Based on GP method, BA was assessed manually by two radiologists and automatically by two deep learning-based BA assessment (DLBAA), which estimated GP-assigned (original model) and optimal (modified model) BAs. Estimated BA was compared to chronological age (CA) using intraclass correlation (ICC), Bland-Altman analysis, linear regression, mean absolute error, and root mean square error. The proportion of children showing a difference >12 months between the estimated BA and CA was calculated. RESULTS CA and all estimated BA showed excellent agreement (ICC ≥0.978, p<0.001) and significant positive linear correlations (R²≥0.935, p<0.001). The estimated BA of all methods showed systematic bias and tended to be lower than CA in younger patients, and higher than CA in older patients (regression slopes ≤-0.11, p<0.001). The mean absolute error of radiologist 1, radiologist 2, original, and modified DLBAA models were 13.09, 13.12, 11.52, and 11.31 months, respectively. The difference between estimated BA and CA was >12 months in 44.3%, 44.5%, 39.2%, and 36.1% for radiologist 1, radiologist 2, original, and modified DLBAA models, respectively. CONCLUSION Contemporary healthy Korean children showed different rates of skeletal development than GP standard-BA, and systemic bias should be considered when determining children's skeletal maturation.
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Affiliation(s)
- Jisun Hwang
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Jae-Yeon Hwang
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, Korea.
| | - Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Boram Bak
- University of Ulsan Foundation for Industry Cooperation, Ulsan, Korea
| | | | | | - Hwa Jung Kim
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ah Young Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young Ah Cho
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jin Seong Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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12
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Mancini A, Martone D, Vitucci D, Capobianco A, Alfieri A, Buono P, Orrù S. Influence of Sport Practice and Body Weight on Physical Fitness in Schoolchildren Living in the Campania Region. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127412. [PMID: 35742659 PMCID: PMC9223406 DOI: 10.3390/ijerph19127412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/12/2022] [Accepted: 06/14/2022] [Indexed: 02/01/2023]
Abstract
Background: Physical fitness (PF) levels correlate with health hallmarks at all ages. In this study, w aimed to determine the PF level of schoolchildren from the Campania Region (Italy) through health-related PF (HRPF) components, taking into account body weight and sport practice (SP). Methods: PF level was determined in 565 schoolchildren aged 10−13 (11.7 ± 1.0 yrs; m: 353, f: 212) using some of the Eurofit battery tests. Results: 77% children practiced sport, boys more than girls (86% vs. 63%, respectively; p < 0.05). Boys performed better than girls (p < 0.05) in the Plate Tapping, Standing Broad Jump, Bent-Arm Hang, and 10 × 5 m Shuttle Run tests; girls performed better in the Sit-and-Reach Test (p < 0.05). Conclusion: Overweight/obese status negatively affects the muscular strength of lower limbs, even if it progressively improves during growth. SP was revealed to be a determinant in performance only in some PF tests, likely due to the heterogeneous training level among boys and girls who practice sport.
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Affiliation(s)
- Annamaria Mancini
- Dipartimento di Scienze Motorie e del Benessere, Università degli Studi di Napoli Parthenope, 80133 Naples, Italy; (A.M.); (D.M.); (D.V.); (A.C.); (A.A.); (P.B.)
- CEINGE Biotecnologia Avanzate “Franco Salvatore”, 80145 Naples, Italy
| | - Domenico Martone
- Dipartimento di Scienze Motorie e del Benessere, Università degli Studi di Napoli Parthenope, 80133 Naples, Italy; (A.M.); (D.M.); (D.V.); (A.C.); (A.A.); (P.B.)
- CEINGE Biotecnologia Avanzate “Franco Salvatore”, 80145 Naples, Italy
| | - Daniela Vitucci
- Dipartimento di Scienze Motorie e del Benessere, Università degli Studi di Napoli Parthenope, 80133 Naples, Italy; (A.M.); (D.M.); (D.V.); (A.C.); (A.A.); (P.B.)
- CEINGE Biotecnologia Avanzate “Franco Salvatore”, 80145 Naples, Italy
| | - Adriano Capobianco
- Dipartimento di Scienze Motorie e del Benessere, Università degli Studi di Napoli Parthenope, 80133 Naples, Italy; (A.M.); (D.M.); (D.V.); (A.C.); (A.A.); (P.B.)
| | - Andreina Alfieri
- Dipartimento di Scienze Motorie e del Benessere, Università degli Studi di Napoli Parthenope, 80133 Naples, Italy; (A.M.); (D.M.); (D.V.); (A.C.); (A.A.); (P.B.)
- CEINGE Biotecnologia Avanzate “Franco Salvatore”, 80145 Naples, Italy
| | - Pasqualina Buono
- Dipartimento di Scienze Motorie e del Benessere, Università degli Studi di Napoli Parthenope, 80133 Naples, Italy; (A.M.); (D.M.); (D.V.); (A.C.); (A.A.); (P.B.)
- CEINGE Biotecnologia Avanzate “Franco Salvatore”, 80145 Naples, Italy
| | - Stefania Orrù
- Dipartimento di Scienze Motorie e del Benessere, Università degli Studi di Napoli Parthenope, 80133 Naples, Italy; (A.M.); (D.M.); (D.V.); (A.C.); (A.A.); (P.B.)
- CEINGE Biotecnologia Avanzate “Franco Salvatore”, 80145 Naples, Italy
- Correspondence:
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13
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Zarzeczny R, Kuberski M, Suliga E. The Effect of Three-Year Swim Training on Cardio-Respiratory Fitness and Selected Somatic Features of Prepubertal Boys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127125. [PMID: 35742374 PMCID: PMC9222604 DOI: 10.3390/ijerph19127125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022]
Abstract
The data regarding somatic and physiological effects of sport-related physical activities in youth are limited. Moreover, whether exercise training is capable of increasing cardio-respiratory fitness remains a disputable issue. The study undertook to assess the effect of swimming training on cardio-respiratory fitness (CRF) and the development of physical traits in prepubertal boys, and to determine which of the traits is the best predictor of their CRF. Forty 10-year old prepubertal boys (10.5 ± 0.3 y) were divided into two groups (swimmers (SG), n = 20, and controls (CG), n = 20), which underwent anthropometric measurements and performed a 20 m shuttle run test (20 mSRT) semi-annually over a 3-year period. CRF indices (the number of 20 mSRT shuttles, maximal speed, and VO2max) were higher overall in the SG compared with the CG (p < 0.001). The values of the main physique variables increased faster in the CG, but the groups showed no differentiation of physical traits. In both groups, CRF indices were associated with the participants’ physical traits, the most strongly with the sum of four skinfold thicknesses in the SG and knee breadth in the CG. These results suggest that swimming training is a form of additional physical activity that improves prepubertal boys’ CRF but does not significantly affect their physical development. In using the 20 mSRT to assess the CRF of prepubertal boys, their physical activity level and age-related changes in body fatness need to be considered.
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Affiliation(s)
- Ryszard Zarzeczny
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University, 5 Żeromskiego Str., 25-369 Kielce, Poland;
- Correspondence:
| | - Mariusz Kuberski
- Chair of Physical Culture Sciences, Jan Długosz University in Częstochowa, 13/15 Armii Krajowej Str., 42-200 Częstochowa, Poland;
| | - Edyta Suliga
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University, 5 Żeromskiego Str., 25-369 Kielce, Poland;
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14
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Stevens P, Desperes M, McClure PK, Presson A, Herrick J. Growth Deceleration for Limb Length Discrepancy: Tension Band Plates Followed to Maturity. Strategies Trauma Limb Reconstr 2022; 17:26-31. [PMID: 35734037 PMCID: PMC9166257 DOI: 10.5005/jp-journals-10080-1548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Peter Stevens
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, United States of America
- Peter Stevens, Department of Orthopedics, University of Utah, Salt Lake City, Utah, United States of America, Phone: +8013303656, e-mail:
| | - Matias Desperes
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, United States of America
| | - Philip K McClure
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, United States of America
| | - Angela Presson
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, United States of America
| | - Jennifer Herrick
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, United States of America
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15
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Rapid Spike in Hip Adduction Strength in Early Adolescent Footballers: A Study of 125 Elite Male Players From Youth to Senior. Int J Sports Physiol Perform 2022; 17:1407-1414. [PMID: 35534012 DOI: 10.1123/ijspp.2022-0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/21/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate the differences in hip adductor and abductor muscle strength in elite male footballers from youth to senior level. METHODS We tested 125 players from the under-13-years (U'13) to senior squads of a Danish male professional football club in this cross-sectional design study. Hip adductor and abductor force (in newtons), torque (in newton meters), normalized torque (in newton meters per body mass), and adduction-to-abduction ratio were measured using handheld dynamometry. RESULTS Between U'13 and senior level, adductor force increased by 104%, torque by 127%, and normalized torque by 21%. Abductor force increased by 78%, torque by 126%, and normalized torque by 17%. For incremental differences between age groups, significant increases were observed between the ages of U'13 to U'14 (18%-39%) and U'14 to U'15 (19%-33%) for all strength measures (P ≤ .021). No incremental difference was observed for adductor-to-abductor ratio. CONCLUSIONS The large increases in hip adductor and abductor strength occurring between the ages of U'13 and U'15 offer insight into the strength capabilities and stress demands in these players, which may relate to injury vulnerability, and facilitate clinicians in selecting best-suited exercise interventions.
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16
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Cancino B, Muñoz C, Tuca MJ, Birrer EAM, Sepúlveda MF. Anterior Cruciate Ligament Rupture in Skeletally Immature Patients. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202205000-00007. [PMID: 35588096 PMCID: PMC10531303 DOI: 10.5435/jaaosglobal-d-21-00166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 03/15/2022] [Indexed: 06/15/2023]
Abstract
In the past 20 years, sports injuries in pediatric and adolescent athletes have increased dramatically, with anterior cruciate ligament (ACL) injuries accounting for more than 25% of all knee injuries at this age. Diagnosis is based on detailed clinical history, physical examination, and imaging assessment, where magnetic resonance imaging plays a central role. The growing immature skeleton presents specific characteristics, which require unique methods for surgical reconstruction, ideally avoiding the physes or minimizing the risk of damaging them. Specific rehabilitation protocols are needed, and these patients face a higher risk of recurrent and contralateral ACL injury. Nonsurgical treatment or delayed reconstruction has been associated with persistent instability, activity modifications, worst functional outcomes, and increased risk of irreparable injuries to menisci and articular cartilage. Consequently, surgical stabilization is the preferred treatment for most patients, despite the eventual risk of angular deformities or limb-length discrepancies due to iatrogenic physeal injury. A variety of surgical techniques have been described, depending on the skeletal maturity and growth remaining. Targeted prevention programs play a key role in reducing the risk of ACL injury, are easy to implement, and require no additional equipment. High-quality evidence supports its use in all pediatric athletes.
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Affiliation(s)
- Benjamín Cancino
- From the Universidad Austral de Chile, Valdivia, Chile (Dr. Cancino, Dr. Muñoz, Dr. Birrer, and Dr. Sepúlveda); the Clínica Alemana, Santiago, Chile (Dr. Tuca); the Universidad del Desarrollo, Santiago, Chile (Dr. Tuca); the Hospital Clínico Mutual de Seguridad, Santiago, Chile (Dr. Tuca); and Hospital Base de Valdivia, Valdivia, Chile (Dr. Birrer, and Dr. Sepúlveda)
| | - Carlos Muñoz
- From the Universidad Austral de Chile, Valdivia, Chile (Dr. Cancino, Dr. Muñoz, Dr. Birrer, and Dr. Sepúlveda); the Clínica Alemana, Santiago, Chile (Dr. Tuca); the Universidad del Desarrollo, Santiago, Chile (Dr. Tuca); the Hospital Clínico Mutual de Seguridad, Santiago, Chile (Dr. Tuca); and Hospital Base de Valdivia, Valdivia, Chile (Dr. Birrer, and Dr. Sepúlveda)
| | - María Jesús Tuca
- From the Universidad Austral de Chile, Valdivia, Chile (Dr. Cancino, Dr. Muñoz, Dr. Birrer, and Dr. Sepúlveda); the Clínica Alemana, Santiago, Chile (Dr. Tuca); the Universidad del Desarrollo, Santiago, Chile (Dr. Tuca); the Hospital Clínico Mutual de Seguridad, Santiago, Chile (Dr. Tuca); and Hospital Base de Valdivia, Valdivia, Chile (Dr. Birrer, and Dr. Sepúlveda)
| | - Estefanía A. M. Birrer
- From the Universidad Austral de Chile, Valdivia, Chile (Dr. Cancino, Dr. Muñoz, Dr. Birrer, and Dr. Sepúlveda); the Clínica Alemana, Santiago, Chile (Dr. Tuca); the Universidad del Desarrollo, Santiago, Chile (Dr. Tuca); the Hospital Clínico Mutual de Seguridad, Santiago, Chile (Dr. Tuca); and Hospital Base de Valdivia, Valdivia, Chile (Dr. Birrer, and Dr. Sepúlveda)
| | - Matías F. Sepúlveda
- From the Universidad Austral de Chile, Valdivia, Chile (Dr. Cancino, Dr. Muñoz, Dr. Birrer, and Dr. Sepúlveda); the Clínica Alemana, Santiago, Chile (Dr. Tuca); the Universidad del Desarrollo, Santiago, Chile (Dr. Tuca); the Hospital Clínico Mutual de Seguridad, Santiago, Chile (Dr. Tuca); and Hospital Base de Valdivia, Valdivia, Chile (Dr. Birrer, and Dr. Sepúlveda)
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17
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Zachurzok A, Mayr J, Rutz E, Tomaszewski R. Dimensions of the anterior cruciate ligament and thickness of the distal femoral growth plate in children: a MRI-based study. Arch Orthop Trauma Surg 2022; 143:2363-2372. [PMID: 35438332 DOI: 10.1007/s00402-022-04441-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND When determining the dimensions of an anterior cruciate ligament (ACL) graft in children, bone age should be considered in addition to the patient's age, gender, and body height. OBJECTIVES We aimed to determine the relationship between age, gender, and ACL dimensions as well as thickness of growth plate cartilage of the distal femur during puberty. METHODS We retrospectively analyzed MRI scans of the knee in 131 children (82 girls, 49 boys) aged 6-18 years (mean age: 14.9 ± 2.6 years). ACL length and width as well as thickness of the growth plate cartilage at the distal femoral epiphysis were measured. RESULTS Mean ACL length increased linearly up to the age of 12 years in females and 14 years in males; thereafter, mean ACL length remained constant. Mean ACL length was largest at the age of 12 to < 13 years (38.18 mm) in females and at 15 to < 16 years (39.38 mm) in males. Mean ACL width increased up to the age of 12 years in girls and 13 years in boys. After the age of 12 years, both the ACL length and width were significantly larger in boys than girls (p = 0.002 and p = 0.045, respectively). Mean thickness of the growth plate cartilage of the distal femur remained stable up to the age of 12 years in girls and 14 years in boys. Thickness of the growth plate cartilage changed most markedly between the age intervals of 11 to < 12 years and 12 to < 13 years in girls and between the age intervals of 13 to < 14 years and 14 to < 15 years in boys. CONCLUSIONS ACL dimensions depended on both age and gender during the growth period. Measurement of cartilage thickness of the femoral distal growth plate proved to be an objective parameter to assess the maturation stage of local bone. This may be useful for the planning and timing of orthopedic ACL procedures. LEVEL OF EVIDENCE III-retrospective cohort study.
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Affiliation(s)
- Agnieszka Zachurzok
- Department of Pediatrics and Pediatric Endocrinology, School of Medicine, Medical University of Silesia, Katowice, Poland
| | - Johannes Mayr
- Department of Pediatric Surgery, University Children's Hospital of Basel, University of Basel, Basel, Switzerland
| | - Erich Rutz
- Paediatric Orthopaedic Department, The Royal Children's Hospital, Parkville, VIC 2052, Australia. .,Department of Paediatrics, Bob Dickens Chair for Paediatric Orthopaedic Surgery, The University of Melbourne, Melbourne, VIC 3052, Australia. .,Hugh Williamson Gait Analysis Laboratory, The Royal Children's Hospital, Melbourne, VIC 3052, Australia. .,Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia. .,Medical Faculty, University of Basel, 4001, Basel, Switzerland.
| | - Ryszard Tomaszewski
- Institute of Biomedical Engineering, Faculty of Science and Technology, University of Silesia, Katowice, Poland.,Department of Pediatric Traumatology and Orthopedics, Upper Silesian Child Centre, Katowice, Poland
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18
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[Epiphysiodesis and hemiepiphysiodesis : Physeal arrest and guided growth for the lower extremity]. DER ORTHOPADE 2022; 51:415-432. [PMID: 35357554 PMCID: PMC9050799 DOI: 10.1007/s00132-022-04219-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 10/27/2022]
Abstract
The principals of growth arrest by epiphysiodesis and growth guidance by hemiepiphysiodesis are effective and powerful surgical techniques in pediatric orthopedics. These procedures can be used to correct leg length discrepancies as well as sagittal, coronal and oblique deformities. A differentiation is made between temporary and permanent techniques. The most significant advantage is that these techniques are minimally invasive and have low complication rates compared to acute osteotomy and gradual deformity correction. For optimal outcome an exact preoperative planning is needed to ensure accurate timing of the procedure, especially when permanent epiphysiodesis techniques are used. Although epiphysiodesis and hemiepiphysiodesis around the pediatric knee are most frequently used and can be considered the gold standard treatment of coronal plane deformities and leg length discrepancies, novel techniques for the hip and ankle are increasingly being performed. The successful clinical results with low complications support the broad use of hemiepiphysiodesis and epiphysiodesis for a variety of indications in the growing skeleton with deformities and leg length differences.
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19
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Mandal D, Ray U, Ghosh P. Differences in skeletal growth pattern of yoga practising adolescent girls: A cross-sectional study. J Ayurveda Integr Med 2022; 13:100550. [PMID: 35255268 PMCID: PMC8904604 DOI: 10.1016/j.jaim.2022.100550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 04/26/2021] [Accepted: 01/23/2022] [Indexed: 11/28/2022] Open
Abstract
Background Yogasana improves both mental and physical health. There is sparse systematic research on the growth of yogasana practising adolescents. Objectives This study aims to assess the differential skeletal growth pattern among pre-adolescent and adolescent girls as a result of yoga practice. Methods A cross-sectional anthropometric study was conducted on stature (height), sitting height and leg length of 757 school-going girls (4-15 years old), divided in two groups, Yoga Group (YG) (n=380) and age matched Control Group (CG) (n=377) participants participating in recreational games other than yoga. Descriptive and inferential statistical analyses were applied. Unpaired t-test was performed for assessment of level of significance and Pearson's correlation (r) test was performed to to identify the association between growth pattern of stature and leg length at specific ages. Results The physical growth showed an ascending trend in both Yoga group (YG)2 participants and control group (CG)3 . At the onset of adolescence (10–12 years) the mean stature and leg length of YG participants were retarded (p < 0.05). Sitting height in YG was significantly (p < 0.05) low only in 10-year-olds. The similar trends were observed in stature and leg length in YG participants at 10 years (5th and 10th percentile) and 12 years (90th and 95th percentile). There was strong positive relationship between stature and leg length of YG participants (10 years, r = 0.86, p < 0.01; 11 years, r = 0.86, p < 0.01; 12 years, r = 0.72, p < 0.01). The stunted growth in YG participants during adolescence may be related to retarded growth of leg length. Conclusions Intense yogasana practice with greater skeletal stress possibly hinders stature in adolescent girls from 10 to 12 years. This may compromise with the natural growth pattern, necessitating special care during yoga training among adolescents while selecting the type, intensity and duration of yogasanas practice.
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Affiliation(s)
- Debjani Mandal
- Department of Physiology, West Bengal State University, Barasat, Kolkata, 700126, India
| | - UdaySankar Ray
- Department of Physiology, West Bengal State University, Barasat, Kolkata, 700126, India
| | - Pratiti Ghosh
- Department of Physiology, West Bengal State University, Barasat, Kolkata, 700126, India.
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20
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Controversies in the management of anterior cruciate ligament injuries in skeletally immature patients. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Jang WY, Ahn KS, Oh S, Lee JE, Choi J, Kang CH, Kang WY, Hong SJ, Shim E, Kim BH, Je BK, Jung HW, Lee SH. Difference between bone age at the hand and elbow at the onset of puberty. Medicine (Baltimore) 2022; 101:e28516. [PMID: 35029913 PMCID: PMC8735777 DOI: 10.1097/md.0000000000028516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/17/2021] [Indexed: 11/25/2022] Open
Abstract
In the pubertal period, bone age advances rapidly in conjunction with growth spurts. Precise bone-age assessments in this period are important, but results from the hand and elbow can be different. We aimed to compare the bone age between the hand and elbow around puberty onset and to elucidate the chronological age confirming puberty onset according to elbow-based bone age.A total of 211 peripubertal subjects (127 boys and 84 girls) who underwent hand and elbow radiographs within 2 months was enrolled. Two radiologists and a pediatric orthopedic surgeon assessed bone age. Hand bone age was graded using the Greulich-Pyle (GP) method, and elbow bone age was determined using the Sauvegrain method. The correlation of 2 methods was evaluated by Demining regression analysis, and the mean absolute difference (MAD) with chronological age was compared between pre-pubertal and pubertal subjects. Receiver-operating characteristic curve analysis was performed to determine the chronological age confirming puberty onset.There was a statistically significant difference in bone age revealed by the GP and Sauvegrain methods in the pubertal group. In the pubertal group, the MAD was 1.26 ± 0.90 years with the GP method and 0.61 ± 0.47 years with the Sauvegrain method in boys (P < .001), while in girls, the MAD was 0.84 ± 0.60 years and 0.53 ± 0.36 years with the same 2 methods (P = .033). The chronological age for confirming puberty onset using the elbow was 12.2 years in boys and 10.3 years in girls.The bone ages of hand and elbow were different at puberty, and the elbow was a more reliable location for bone-age assessment at puberty. Puberty onset according to elbow occurred slightly earlier than expected.
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Affiliation(s)
- Woo Young Jang
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Kyung-Sik Ahn
- Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Saelin Oh
- Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Ji Eun Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jimi Choi
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chang Ho Kang
- Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Woo Young Kang
- Department of Radiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Suk-Joo Hong
- Department of Radiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Eddeum Shim
- Department of Radiology, Korea University Ansan Hospital, Gyeonggi-do, Republic of Korea
| | - Baek Hyun Kim
- Department of Radiology, Korea University Ansan Hospital, Gyeonggi-do, Republic of Korea
| | - Bo-Kyung Je
- Department of Radiology, Korea University Ansan Hospital, Gyeonggi-do, Republic of Korea
| | - Hae Woon Jung
- Department of Pediatrics, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Soon Hyuck Lee
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
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22
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Apibantaweesakul S, Omura S, Qi W, Shiotani H, Evangelidis PE, Sado N, Tanaka F, Kawakami Y. Characteristics of inhomogeneous lower extremity growth and development in early childhood: a cross-sectional study. BMC Pediatr 2021; 21:552. [PMID: 34872516 PMCID: PMC8647383 DOI: 10.1186/s12887-021-02998-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early childhood is a transferring stage between the two accelerated growth periods (infant and adolescent). Body dimensions are related to physical growth and development. The purpose of this study was to investigate physical growth in terms of anthropometry, muscle growth of the lower extremity, and functional development over early childhood. METHODS A cross-sectional study was carried out on 29 preschool children (PS: 3-5 years), 21 school children (SC: 6-8 years), and 22 adults (AD: 20-35 years). Lower extremity characteristics (segmental dimensions, muscle and adipose tissue thicknesses of the thigh and lower leg), and voluntary joint torque (knee and ankle) were measured. Correlations between parameters and group comparisons were performed. RESULTS All the parameters except for body mass index (BMI) and subcutaneous adipose tissue thickness were correlated with age for PS and SC combined (r = 0.479-0.920, p < 0.01). Relative thigh and shank lengths to body height were greatest in AD and smallest in PS (p < 0.05) but the relative foot dimensions were significantly larger in PS and SC than in AD (p < 0.05). Relative subcutaneous adipose tissue thickness was largest in PS and lowest in AD. Muscle thickness and the muscle volume measure (estimated from muscle thickness and limb length) were significantly larger in older age groups (p < 0.05). All groups showed comparable muscle thickness when normalized to limb length. Joint torque normalized to estimated muscle volume was greatest for AD, followed by SC and PS (p < 0.05). CONCLUSIONS Relative lower extremity lengths increase with age, except for the foot dimensions. Muscle size increases with age in proportion to the limb length, while relative adiposity decreases. Torque-producing capacity is highly variable in children and rapidly develops toward adulthood. This cross-sectional study suggests that children are not a small scale version of adults, neither morphologically nor functionally.
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Affiliation(s)
- Sudarat Apibantaweesakul
- Graduate School of Sport Sciences, Waseda University, Saitama, 359-1192, Japan
- Department of Sports Science and Sports Development, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, 12121, Thailand
| | - Shiho Omura
- Graduate School of Sport Sciences, Waseda University, Saitama, 359-1192, Japan
| | - Weihuang Qi
- Waseda Institute for Sport Sciences, Waseda University, Saitama, 359-1192, Japan
| | - Hiroto Shiotani
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
- Human Performance Laboratory, Comprehensive Research Organization, Waseda University, Saitama, 359-1192, Japan
| | - Pavlos E Evangelidis
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
| | - Natsuki Sado
- Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, 305-8574, Japan
| | - Fumiko Tanaka
- Human Performance Laboratory, Comprehensive Research Organization, Waseda University, Saitama, 359-1192, Japan
| | - Yasuo Kawakami
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan.
- Human Performance Laboratory, Comprehensive Research Organization, Waseda University, Saitama, 359-1192, Japan.
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23
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Wilson K, Usami Y, Hogarth D, Scheiber AL, Tian H, Oichi T, Wei Y, Qin L, Otsuru S, Toyosawa S, Iwamoto M, Abzug JM, Enomoto-Iwamoto M. Analysis of Association between Morphometric Parameters of Growth Plate and Bone Growth of Tibia in Mice and Humans. Cartilage 2021; 13:315S-325S. [PMID: 31997656 PMCID: PMC8804827 DOI: 10.1177/1947603519900800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The purposes of this study are to evaluate which growth plate parameters are associated with bone growth in mice and to compare the mouse results with those in humans. DESIGN The sagittal sections of the proximal growth plate of the mouse tibia from neonate to young adult stages were subjected to histomorphometric and functional analyses. The radiographic images of tibias of human patients until puberty were analyzed to obtain the tibia length and the proximal growth plate height. It was found that a linear correlation best modeled the relationship between the growth plate variables with the tibia growth rate and length. RESULTS In mice, total height, resting zone height, combined height of the proliferation and prehypertrophic zones, proliferation activity, and the total width of tibia growth plate showed high linear correlation with tibia bone length and bone growth rate, but the hypertrophic zone height and the growth plate area did not. In both mice and humans, the total growth plate width of tibia was found to have the strongest correlation with tibia length and growth rate. CONCLUSIONS The results validated that growth plate total height, the height of the resting zone and cell proliferation activity are appropriate parameters to evaluate the balance between growth plate activity and bone growth in mice, consistent with previous reports. The study also provided a new growth plate parameter candidate, growth plate width for growth plate activity evaluation in both mouse and human tibia bone.
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Affiliation(s)
- Kimberly Wilson
- Department of Orthopaedics, School of
Medicine, University of Maryland, Baltimore, MD, USA
| | - Yu Usami
- Department of Oral Pathology, Osaka
University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Danielle Hogarth
- Department of Orthopaedics, School of
Medicine, University of Maryland, Baltimore, MD, USA
| | - Amanda L. Scheiber
- Department of Orthopaedics, School of
Medicine, University of Maryland, Baltimore, MD, USA
| | - Hongying Tian
- Department of Orthopaedics, School of
Medicine, University of Maryland, Baltimore, MD, USA
| | - Takeshi Oichi
- Department of Orthopaedics, School of
Medicine, University of Maryland, Baltimore, MD, USA
| | - Yulong Wei
- Mckay Orthopaedic Research Laboratory,
Department of Orthopaedic Surgery, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, PA, USA
| | - Ling Qin
- Mckay Orthopaedic Research Laboratory,
Department of Orthopaedic Surgery, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, PA, USA
| | - Satoru Otsuru
- Department of Orthopaedics, School of
Medicine, University of Maryland, Baltimore, MD, USA
| | - Satoru Toyosawa
- Department of Oral Pathology, Osaka
University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Masahiro Iwamoto
- Department of Orthopaedics, School of
Medicine, University of Maryland, Baltimore, MD, USA
| | - Joshua M. Abzug
- Department of Orthopaedics, School of
Medicine, University of Maryland, Baltimore, MD, USA
| | - Motomi Enomoto-Iwamoto
- Department of Orthopaedics, School of
Medicine, University of Maryland, Baltimore, MD, USA,Motomi Enomoto-Iwamoto, Department of
Orthopaedics, School of Medicine, University of Maryland, Baltimore, 20 Penn
Street, HSFII S022, Baltimore, MD, 21209, USA.
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24
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Birch JG, Makarov MR, Sanders JO, Podeszwa DA, Honcharuk EM, Esparza M, Tran EY, Jo CH, Rodgers JA. Lower-Extremity Segment-Length Prediction Accuracy of the Sanders Multiplier, Paley Multiplier, and White-Menelaus Formula. J Bone Joint Surg Am 2021; 103:1713-1717. [PMID: 34166322 DOI: 10.2106/jbjs.20.01923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several methods are available to estimate leg lengths at maturity to facilitate the determination of timing of epiphysiodesis. We compared the Paley multiplier, Sanders multiplier, and White-Menelaus methods in an epiphysiodesis-aged cohort. We assessed intra- and interrater reliability for Sanders skeletal stages and Greulich and Pyle atlas skeletal age. METHODS Actual growth was recorded in healthy, unoperated femoral and tibial segments from an epiphysiodesis database. The predicted and actual lengths were compared with use of the Paley multiplier and White-Menelaus methods, Greulich and Pyle skeletal age, and the Sanders multiplier using Sanders stages. Intra- and interrater reliability were assessed in a separate group of 76 skeletal age films. RESULTS The cohort included 148 femora and 195 tibiae in 197 patients. Femoral length at maturity was slightly underestimated by the Sanders multiplier and staging, was overestimated by the Paley multiplier and skeletal age, and was most accurately predicted with use of the White-Menelaus formula and skeletal age. All methods overestimated tibial length at maturity. The whole-leg prediction accuracy of the Sanders multiplier and White-Menelaus formula were comparable and were more accurate than that of the Paley multiplier. For Sanders skeletal staging, the interrater reliability varied from 0.86 to 0.88 and the intrarater reliability varied from 0.87 to 0.96. For Greulich and Pyle skeletal age, the interrater reliability varied from 0.87 to 0.89 and the intrarater reliability varied from 0.91 to 0.95. CONCLUSIONS Use of the Sanders multiplier and skeletal stages was more accurate than the Paley multiplier and skeletal age in this cohort. Use of the White-Menelaus formula and skeletal age was slightly more accurate in predicting femoral length and slightly less accurate in predicting tibial length compared with the Sanders multiplier. Intra- and interrater reliability were similar between Sanders skeletal stages and Greulich and Pyle atlas skeletal age. The White-Menelaus formula and skeletal age was the recommended method for predicting lower-extremity segment lengths at maturity and epiphysiodesis effect. Although easier to recall without referencing an atlas and not sex-specific, Sanders skeletal staging does not correspond directly to years of growth remaining, and thus cannot be used with the White-Menelaus formula. CLINICAL RELEVANCE The Greulich and Pyle atlas to determine skeletal age and the White-Menelaus formula to determine growth remaining are reliable predictors of epiphysiodesis effect in the lower extremities.
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Affiliation(s)
- John G Birch
- Texas Scottish Rite Hospital for Children, Dallas, Texas
| | | | | | | | | | | | - Elaine Y Tran
- Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Chan-Hee Jo
- Texas Scottish Rite Hospital for Children, Dallas, Texas
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25
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Shinojima A, Kurihara T, Mori K, Iwai Y, Hanyuda A, Negishi K, Torii H, Tsubota K. Association between ocular axial length and anthropometrics of Asian adults. BMC Res Notes 2021; 14:328. [PMID: 34446087 PMCID: PMC8393449 DOI: 10.1186/s13104-021-05745-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/16/2021] [Indexed: 12/05/2022] Open
Abstract
Objective The purpose of this study is to analyze axial length, body height, hand length, and foot length to find new factors that predict myopia and to identify gender differences as one of the factors of high myopia. A cross-sectional study was conducted as a single observation. Body height, hand length, and foot length were measured according to standard anthropometric methods. Axial length, retinal thickness, and choroidal thickness were measured using the IOL Master 700 and the Heidelberg Spectralis-OCT. To account for body height differences among participants, foot length/body height and hand length/body height were analyzed using a mixed-effects model. Results A total of 80 eyes (men, n = 20, 40 eyes; women, n = 20, 40 eyes) were analyzed. The mean age was 33.5 years (range 21–59 years, SD: 9.6). For choroidal thickness, there was a significant association with axial length in men (p < 0.001) and a trend toward an association in women (p = 0.072). There was also a significant association between foot length/body height and axial length in men (p = 0.015), but not in women (p = 0.58). These results suggest that factors that determine body height and foot length may be related to axial length, although they vary by gender.
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Affiliation(s)
- Ari Shinojima
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku ku, Tokyo, 160-8582, Japan.,Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku ku, Tokyo, 160-8582, Japan
| | - Toshihide Kurihara
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku ku, Tokyo, 160-8582, Japan. .,Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku ku, Tokyo, 160-8582, Japan.
| | - Kiwako Mori
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku ku, Tokyo, 160-8582, Japan.,Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku ku, Tokyo, 160-8582, Japan
| | - Yujiro Iwai
- Keio University School of Medicine, 35 Shinanomachi, Shinjuku ku, Tokyo, 160-8582, Japan
| | - Akiko Hanyuda
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku ku, Tokyo, 160-8582, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku ku, Tokyo, 160-8582, Japan
| | - Hidemasa Torii
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku ku, Tokyo, 160-8582, Japan.,Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku ku, Tokyo, 160-8582, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku ku, Tokyo, 160-8582, Japan. .,Tsubota Laboratory, Inc, 304 Toshin Shinanomachi-ekimae Bldg., 34 Shinanomachi, Tokyo, 160-0016, Japan.
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26
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Rauck RC, Apostolakos JM, Nwachukwu BU, Schneider BL, Williams RJ, Dines JS, Altchek DW, Pearle A, Allen A, Stein BS, Dines D, Ranawat A, Kelly A, Kelly B, Rose H, Maynard M, Strickland S, Coleman S, Hannafin J, MacGillivray J, Marx R, Warren R, Rodeo S, Fealy S, O'Brien S, Wickiewicz T. Return to Sport After Bone-Patellar Tendon-Bone Autograft ACL Reconstruction in High School-Aged Athletes. Orthop J Sports Med 2021; 9:23259671211011510. [PMID: 34250173 PMCID: PMC8239981 DOI: 10.1177/23259671211011510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/12/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Anterior cruciate ligament (ACL) injuries are occurring with increasing frequency in the adolescent population. Outcomes after ACL reconstruction (ACLR) are inconsistently reported in homogeneous patient populations. Purpose/Hypothesis: To evaluate outcomes after bone–patellar tendon–bone (BTB) autograft ACLR in competitive high school–aged athletes by examining return to sport (RTS), patient satisfaction, and reinjury rates. Our hypothesis was that RTS rates and satisfaction will be high and reinjury rates will be low. Study Design: Case series; Level of evidence, 4. Methods: An institutional ACL registry was utilized to identify competitive high school–aged athletes (14-18 years old) who underwent primary ACLR using BTB autograft with a minimum 2-year follow-up. A postoperative questionnaire was administered to determine rates and types of RTS, quality of sports performance, reinjury, and satisfaction. Uni- and multivariable analyses were used to identify demographic, sport-specific, and clinical factors related to RTS. Results: A total of 53 patients were included (mean ± SD age at the time of surgery, 16.6 ± 1.34 years). Mean follow-up was 3.78 ± 0.70 years (range, 2.60-4.94 years). The overall ipsilateral ACL retear rate was 7.5% (n = 4). There were 10 subsequent ACL tears to the contralateral knee (19%). Forty-four (83%) patients successfully returned to at least their prior level of sport at a mean 10.5 ± 8.7 months (range, 3-48 months). Overall satisfaction was high, with 91% of patients very satisfied with the outcome. Higher confidence levels regarding performance of the reconstructed knee were associated with increased probability of RTS on multivariate analysis. Conclusion: BTB autograft ACLR results in high rates of RTS and satisfaction and low rates of subsequent ipsilateral ACL injuries in competitive high school–aged athletes. Patients with higher confidence in performance of the reconstructed knee are more likely to return to at least their prior level of sport.
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Affiliation(s)
- Ryan C Rauck
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - John M Apostolakos
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Benedict U Nwachukwu
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Brandon L Schneider
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Riley J Williams
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Joshua S Dines
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - David W Altchek
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | | | - Andrew Pearle
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Answorth Allen
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Beth Shubin Stein
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - David Dines
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Anil Ranawat
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Anne Kelly
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Bryan Kelly
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Howard Rose
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Michael Maynard
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Sabrina Strickland
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Struan Coleman
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Jo Hannafin
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - John MacGillivray
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Robert Marx
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Russell Warren
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Scott Rodeo
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Stephen Fealy
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Stephen O'Brien
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Thomas Wickiewicz
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
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27
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Ahn KS, Bae B, Jang WY, Lee JH, Oh S, Kim BH, Lee SW, Jung HW, Lee JW, Sung J, Jung KH, Kang CH, Lee SH. Assessment of rapidly advancing bone age during puberty on elbow radiographs using a deep neural network model. Eur Radiol 2021; 31:8947-8955. [PMID: 34115194 DOI: 10.1007/s00330-021-08096-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/10/2021] [Accepted: 05/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Bone age is considered an indicator for the diagnosis of precocious or delayed puberty and a predictor of adult height. We aimed to evaluate the performance of a deep neural network model in assessing rapidly advancing bone age during puberty using elbow radiographs. METHODS In all, 4437 anteroposterior and lateral pairs of elbow radiographs were obtained from pubertal individuals from two institutions to implement and validate a deep neural network model. The reference standard bone age was established by five trained researchers using the Sauvegrain method, a scoring system based on the shapes of the lateral condyle, trochlea, olecranon apophysis, and proximal radial epiphysis. A test set (n = 141) was obtained from an external institution. The differences between the assessment of the model and that of reviewers were compared. RESULTS The mean absolute difference (MAD) in bone age estimation between the model and reviewers was 0.15 years on internal validation. In the test set, the MAD between the model and the five experts ranged from 0.19 to 0.30 years. Compared with the reference standard, the MAD was 0.22 years. Interobserver agreement was excellent among reviewers (ICC: 0.99) and between the model and the reviewers (ICC: 0.98). In the subpart analysis, the olecranon apophysis exhibited the highest accuracy (74.5%), followed by the trochlea (73.7%), lateral condyle (73.7%), and radial epiphysis (63.1%). CONCLUSIONS Assessment of rapidly advancing bone age during puberty on elbow radiographs using our deep neural network model was similar to that of experts. KEY POINTS • Bone age during puberty is particularly important for patients with scoliosis or limb-length discrepancy to determine the phase of the disease, which influences the timing and method of surgery. • The commonly used hand radiographs-based methods have limitations in assessing bone age during puberty due to the less prominent morphological changes of the hand and wrist bones in this period. • A deep neural network model trained with elbow radiographs exhibited similar performance to human experts on estimating rapidly advancing bone age during puberty.
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Affiliation(s)
- Kyung-Sik Ahn
- Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | | | - Woo Young Jang
- Department of Orthopedic Surgery, Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
| | - Jin Hyuck Lee
- Department of Sports Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Saelin Oh
- Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Baek Hyun Kim
- Department of Radiology, Korea University Ansan Hospital, Gyeonggi-do, Republic of Korea
| | - Si Wook Lee
- Department of Orthopedic Surgery, Keimyung University, School of Medicine, Dongsan Medical Center, Daegu, Republic of Korea
| | - Hae Woon Jung
- Department of Pediatrics, Kyung Hee University Hospital, Seoul, Republic of Korea
| | | | | | | | - Chang Ho Kang
- Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Soon Hyuck Lee
- Department of Orthopedic Surgery, Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
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28
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Uygun B, Kaya K, Köse S, Ekizoğlu O, Hilal A. Applicability of Magnetic Resonance Imaging of the Knee in Forensic Age Estimation. Am J Forensic Med Pathol 2021; 42:147-154. [PMID: 33148968 DOI: 10.1097/paf.0000000000000634] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Age estimation in forensic medicine practice is of particular importance to the legal systems, and it is one of the current research topics in forensic medicine. Age determination is most frequently performed by radiological methods, but recently, nonionized methods are preferred for nonmedical indications. Therefore, we aimed to examine feasibility of MRI imaging, which provides nonionized, noninvasive, and detailed images, in forensic age estimation and to expand the database on this subject. The MRI images of the patients between the ages of 10 and 25 years, who visited Cukurova University Faculty of Medicine between January 2012 and April 2018 for any reason, were retrospectively analyzed according to the staging method described by Dedouit et al. The stage 5 ossification in distal femoral epiphysis indicated an age over 18 years in both sexes (except for 2 cases of 14 and 15 years). The stage 5 ossification in proximal tibial epiphysis indicated an age older than 18 years (except for 1 male case at the age of 15 years and 2 female cases at the age of 14 and 17 years, respectively). It was determined that stage 1 and stage 2 in both distal femur and proximal tibial epiphysis were last seen in younger than 18 years in both sexes. Our study data show that MRI imaging is a nonionized method that can be used in addition to other radiological methods in determining the age limit of 18 years.
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Affiliation(s)
| | - Kenan Kaya
- From the Department of Forensic Medicine
| | - Sevgül Köse
- Department of Radiology, Cukurova University School of Medicine, Adana
| | - Oğuzhan Ekizoğlu
- Department of Forensic Medicine, Tepecik Training and Research Hospital, İzmir, Turkey
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Willegger M, Schreiner M, Kolb A, Windhager R, Chiari C. Epiphysiodesis for the treatment of tall stature and leg length discrepancy. Wien Med Wochenschr 2021; 171:133-141. [PMID: 33738632 PMCID: PMC8016792 DOI: 10.1007/s10354-021-00828-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/10/2021] [Indexed: 12/14/2022]
Abstract
Painful orthopedic conditions associated with extreme tall stature and leg length discrepancy (LLD) include back pain and adopting bad posture. After failure of conservative treatment options, blocking of the growth plates (epiphysiodesis) around the knee emerged as gold standard in patients with tall stature and LLD in the growing skeleton. Surgical planning includes growth prediction and evaluation of bone age. Since growth prediction is associated with a certain potential error, adequate planning and timing of epiphysiodesis are the key for success of the treatment. LLD corrections up to 5 cm can be achieved, and predicted extreme tall stature can be limited. Percutaneous epiphysiodesis techniques are minimally invasive, safe and efficient methods with low complication rates. In general, a multidisciplinary approach should be pursued when treating children and adolescents with tall stature.
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Affiliation(s)
- Madeleine Willegger
- Department of Orthopedics and Trauma Surgery-Division for Orthopedics, Comprehensive Center for Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Vienna Bone and Growth Center, Vienna, Austria
| | - Markus Schreiner
- Department of Orthopedics and Trauma Surgery-Division for Orthopedics, Comprehensive Center for Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Vienna Bone and Growth Center, Vienna, Austria
| | - Alexander Kolb
- Department of Orthopedics and Trauma Surgery-Division for Orthopedics, Comprehensive Center for Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Vienna Bone and Growth Center, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery-Division for Orthopedics, Comprehensive Center for Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Vienna Bone and Growth Center, Vienna, Austria
| | - Catharina Chiari
- Department of Orthopedics and Trauma Surgery-Division for Orthopedics, Comprehensive Center for Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. .,Vienna Bone and Growth Center, Vienna, Austria.
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30
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Batty B, Kutzler M, Campbell S, Turner R, Bionaz M. Effect of milk vs. sugar-sweetened beverage supplementation on bone development in pre-pubertal pigs as model for children. ITALIAN JOURNAL OF ANIMAL SCIENCE 2020. [DOI: 10.1080/1828051x.2020.1816508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Brandon Batty
- Department of Animal and Rangeland Sciences, Oregon State University, Corvallis, OR, USA
| | - Michelle Kutzler
- Department of Animal and Rangeland Sciences, Oregon State University, Corvallis, OR, USA
| | - Scott Campbell
- Department of Mechanical, Industrial, and Manufacturing Engineering, Oregon State University, Corvallis, OR, USA
| | - Russell Turner
- College of Public Health and Human Science, Oregon State University, Corvallis, OR, USA
| | - Massimo Bionaz
- Department of Animal and Rangeland Sciences, Oregon State University, Corvallis, OR, USA
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Abstract
PURPOSE OF REVIEW Bone elongation is a complex process driven by multiple intrinsic (hormones, growth factors) and extrinsic (nutrition, environment) variables. Bones grow in length by endochondral ossification in cartilaginous growth plates at ends of developing long bones. This review provides an updated overview of the important factors that influence this process. RECENT FINDINGS Insulin-like growth factor-1 (IGF-1) is the major hormone required for growth and a drug for treating pediatric skeletal disorders. Temperature is an underrecognized environmental variable that also impacts linear growth. This paper reviews the current state of knowledge regarding the interaction of IGF-1 and environmental factors on bone elongation. Understanding how internal and external variables regulate bone lengthening is essential for developing and improving treatments for an array of bone elongation disorders. Future studies may benefit from understanding how these unique relationships could offer realistic new approaches for increasing bone length in different growth-limiting conditions.
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Affiliation(s)
- Holly L Racine
- Department of Natural Sciences and Mathematics, West Liberty University, West Liberty, WV, 26074, USA
| | - Maria A Serrat
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, 1 John Marshall Drive, Huntington, WV, 25755, USA.
- Department of Clinical and Translational Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, 25755, USA.
- Department of Orthopaedics, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, 25755, USA.
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Abstract
The increasing incidence of anterior cruciate ligament injuries in skeletally immature children demands careful attention by orthopedic surgeons. Assessing skeletal age is essential to selecting the appropriate reconstruction technique. Males with a bone age of 15 years or older and females of 13 years and older are ideal candidates for a transphyseal anterior cruciate ligament reconstruction because there is minimal risk of growth disturbance. Children with substantial growth remaining (skeletal age males ≤12 years and females ≤10 years) seem to be at risk for more significant growth disturbance, so we generally recommend physeal-sparing techniques for these younger patients.
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Affiliation(s)
- Crystal A Perkins
- Children's Healthcare of Atlanta, 5445 Meridian Mark Road, Suite 250, Atlanta, GA 30342, USA.
| | - S Clifton Willimon
- Children's Healthcare of Atlanta, 5445 Meridian Mark Road, Suite 250, Atlanta, GA 30342, USA
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Ruiz Brunner MM, Cuestas E, Cieri ME, Cuestas E. Reference ranges for knee height in Argentine children and adolescents aged 2 to 18 years. Am J Hum Biol 2019; 32:e23366. [PMID: 31785191 DOI: 10.1002/ajhb.23366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 11/01/2019] [Accepted: 11/17/2019] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Measurement of height is essential in the anthropometric assessment of growth and nutritional status. In some conditions, height measurement may be difficult or impossible. Proxy measurement such as knee height (KH) have been proposed to predict stature in such cases, but reference percentile ranges and charts for healthy, well-nourished children are currently unavailable. This study was designed to develop sex-specific KH reference percentile ranges and charts in Argentine children ranging from 2 to 18 years of age. METHODS We collected and analyzed cross-sectional data for KH from 861 Argentine children and adolescents aged 2 to 18 years. Generalized additive models for location, scale, and shape were used to calculate semiparametric smoothed percentile reference ranges, and charts by age and sex. Linear regression and correlation analyses were performed to know the association between KH and height. RESULTS The new reference ranges show that KH growth rose sharply until puberty. Peak KH velocity occurs 1 year earlier than peak height velocity. At puberty KH growth decelerated rapidly in females and increased slightly until 15 years and plateaued at this age, while it had a more gradual deceleration in males up to 11 years old, later increased slightly until 17 years and plateaued at this age. The correlation coefficient between height and KH was r = 0.98 for both sexes (p < .001). CONCLUSIONS The new reference percentile ranges for KH measures for healthy children and adolescents provide a useful growth and nutritional assessment tool in a wide variety of settings. KH has a strong agreement with stature.
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Affiliation(s)
- Maria M Ruiz Brunner
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Córdoba, Consejo Nacional de Investigaciones Científicas y Técnicas (INICSA-UNC-CONICET), Córdoba, Argentina.,Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Eloisa Cuestas
- Instituto de Física Enrique Gaviola -Consejo Nacional de investigaciones Científicas y Técnicas (IFEG-CONICET), and Facultad de Matemática, Astronomía, Física y Computación - Universidad Nacional de Córdoba (FaMAF-UNC), Córdoba, Argentina
| | - Maria E Cieri
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Córdoba, Consejo Nacional de Investigaciones Científicas y Técnicas (INICSA-UNC-CONICET), Córdoba, Argentina.,Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Eduardo Cuestas
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Córdoba, Consejo Nacional de Investigaciones Científicas y Técnicas (INICSA-UNC-CONICET), Córdoba, Argentina.,Department of Pediatrics and Neonatology, Hospital Privado Universitario de Córdoba. Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
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Sambri A, Staals E, Medellin MR, Abudu A, Gikas P, Pollock R, Briggs TWR, Donati DM, Manfrini M. Stanmore noninvasive extendible endoprosthesis in the treatment of bone sarcoma in the preadolescent. J Surg Oncol 2019; 120:176-182. [DOI: 10.1002/jso.25501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/03/2019] [Accepted: 04/26/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Andrea Sambri
- Orthopedic OncologyIRCCS Istituto Ortopedico RizzoliBologna Italy
| | - Eric Staals
- Orthopedic OncologyIRCCS Istituto Ortopedico RizzoliBologna Italy
| | - Manuel Ricardo Medellin
- Orthopedic OncologyRoyal Orthopaedic Hospital NHS TrustBirmingham UK
- Orthopedic OncologyInstituto Nacional de CancerologiaBogotà Colombia
| | - Adesegun Abudu
- Orthopedic OncologyRoyal Orthopaedic Hospital NHS TrustBirmingham UK
| | - Panagiotis Gikas
- Orthopedic OncologyRoyal National Orthopaedic Hospital NHS TrustLondon UK
| | - Rob Pollock
- Orthopedic OncologyRoyal National Orthopaedic Hospital NHS TrustLondon UK
| | - Tim WR Briggs
- Orthopedic OncologyRoyal National Orthopaedic Hospital NHS TrustLondon UK
| | | | - Marco Manfrini
- Orthopedic OncologyIRCCS Istituto Ortopedico RizzoliBologna Italy
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Is Anteromedial Drilling Safe in Transphyseal Anterior Cruciate Ligament Reconstruction in Adolescents with Growth Remaining? J Pediatr Orthop 2019; 39:e278-e283. [PMID: 30702639 DOI: 10.1097/bpo.0000000000001289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous reports of transphyseal drilling in anterior cruciate ligament (ACL) reconstruction have demonstrated good clinical outcomes without subjective changes in further skeletal development. The purpose of this study is to evaluate radiographic changes during continued growth following a transphyseal ACL reconstruction using an anteromedial femoral (AM) drilling technique in patients with >18 months of growth remaining. METHODS A review of consecutive adolescents who underwent a soft tissue transphyseal ACL reconstruction using an AM drilling technique was performed. Inclusion criteria was 18 months of growth remaining based on radiographic bone age and standing radiographs at least one year from the index procedure. Demographic, preoperative, and postoperative data, and follow-up three-foot standing lower extremity radiographs were reviewed. Radiographic data included femoral length, tibial length, total lower extremity length, mechanical axis deviation (MAD), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA). RESULTS In total 12 adolescent patients with a mean age of 13.4 years (range, 12.3 to 14.4) and bone age of 13.4 years (11.5 to 14) at the time of surgery were included. At an average of 2.27-year follow-up (412 to 1058 d), there was no difference in the total growth of the operative and nonoperative limb (48.5 mm vs. 47 mm; P=0.36). In addition, the average increases in femoral length (23.4 mm) and tibial length (25.8 mm) were not statistically different between the operative and the nonoperative limb (P=0.12; P=0.75). There was no statistical difference in mechanical axis deviation, LDFA, or MPTA between preoperative and postoperative radiographs. Mean differences in operative and nonoperative coronal angular changes were all <1.5 degrees. CONCLUSIONS With at least 2 years of growth remaining, transphyseal ACL reconstruction with anteromedial drilling did not significantly affect the physis or residual growth compared with the contralateral extremity. Although this technique may create a larger defect in the physis, standing radiographs demonstrate there is no change in limb length or angulation in growing adolescents approximately 2 years after surgery. LEVEL OF EVIDENCE This is a case series; Level IV evidence.
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Li Y, Xu H, Shan H, Sun Y, Huang Z, Niu X. [Application of proximal tibial hemiprosthesis replacement and second-stage revision for proximal tibial osteosarcoma in three children]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:131-137. [PMID: 30739403 DOI: 10.7507/1002-1892.201810022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the feasibility and effectiveness of proximal tibial hemiprosthesis replacement in the first stage and prosthesis revision in the second stage in reducing the risk of length discrepancy of limbs in children with proximal tibial osteosarcoma. Methods Between 2009 and 2013, 3 children with conventional osteosarcoma at the proximal tibia (stage ⅡB) were treated. There were 2 boys and 1 girl. They were 12, 13, and 13 years old, respectively. After 4 courses of preoperative chemotherapy, the proximal tumor segmental resection and proximal tibial hemiprosthesis replacement were performed. Then the patients underwent prosthetic revision in the second stage when they were 20, 17, and 17 years old, respectively. Results All patients successfully completed two stages of operations. The length discrepancy of lower limb after the second stage operation were 19, 7, and 21 mm, respectively. Three patients were followed up 13, 3, and 27 months after the second stage operation, and the lower extremities functions were satisfactory. The Musculoskeletal Tumor Society (MSTS) score was 26, 27, and 25, respectively. Conclusion The proximal tibial hemiprosthesis replacement in the first stage combined with prosthesis revision in the second stage for treating the proximal tibia osteosarcoma in children can keep the distal femur growth ability, reduce the length discreapancy of lower limb, and obtain satisfactory stability and good function.
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Affiliation(s)
- Yuan Li
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Beijing, 100035, P.R.China
| | - Hairong Xu
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Beijing, 100035, P.R.China
| | - Huachao Shan
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Beijing, 100035, P.R.China
| | - Yang Sun
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Beijing, 100035, P.R.China
| | - Zhen Huang
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Beijing, 100035, P.R.China
| | - Xiaohui Niu
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Beijing, 100035,
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Foster AD. The impact of bipedal mechanical loading history on longitudinal long bone growth. PLoS One 2019; 14:e0211692. [PMID: 30730948 PMCID: PMC6366785 DOI: 10.1371/journal.pone.0211692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 01/20/2019] [Indexed: 12/21/2022] Open
Abstract
Longitudinal bone growth is accomplished through a process where proliferating chondrocytes produce cartilage in the growth plate, which ultimately ossifies. Environmental influences, like mechanical loading, can moderate the growth of this cartilage, which can alter bone length. However, little is known about how specific behaviors like bipedalism, which is characterized by a shift in body mass (mechanical load), to the lower limbs, may impact bone growth. This study uses an experimental approach to induce bipedal behaviors in a rodent model (Rattus norvegicus) over a 12-week period using a treadmill-mounted harness system to test how rat hindlimbs respond to the following loading conditions: 1) fully loaded bipedal walking, 2) partially loaded bipedal walking, 3) standing, 4) quadrupedal walking, and 5) no exercise control. These experimental conditions test whether mechanical loading from 1) locomotor or postural behaviors, and 2) a change in the magnitude of load can moderate longitudinal bone growth in the femur and tibia, relative to controls. The results demonstrate that fully loaded bipedal walking and bipedal standing groups showed significant differences in the percentage change in length for the tibia and femur. When comparing the change from baseline, which control for body mass, all bipedal groups showed significant differences in tibia length compared to control groups. However, there were no absolute differences in bone length, which suggests that mechanical loads from bipedal behaviors may instead be moderating changes in growth velocity. Implications for the relationship between bipedal behaviors and longitudinal bone growth are discussed.
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Affiliation(s)
- Adam D. Foster
- Department of Anatomy, School of Osteopathic Medicine, Campbell University, Buies Creek, North Carolina, United States of America
- * E-mail:
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Outcomes and subjective assessment of rotation-plasty in patients with proximal femoral focal deficiency. J Pediatr Orthop B 2018; 27:503-509. [PMID: 29851714 DOI: 10.1097/bpb.0000000000000515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
This study presents outcomes of rotation-plasty for unilateral proximal femoral focal deficiency in the adolescent population. The function, timing of knee fusion, and complications were presented as well as patients' assessment of their function and appearance. Eight patients, aged 8.37 years (range: 3-16 years) during surgery, were evaluated. The mean follow-up duration was 9.25 years (range: 6-12 years). At follow-up, all the patients were pain free and able to ambulate outdoors. Complications included derotation of the foot in five patients, necessitating a re-rotation osteotomy in two. All patients accepted their appearance, considering the rotation-plasty beneficial for their functional status.
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Tsai A, Laor T, Estroff JA, Kasser JR. Constant inhibition in congenital lower extremity shortening: does it begin in utero? Pediatr Radiol 2018; 48:1451-1462. [PMID: 29797037 DOI: 10.1007/s00247-018-4153-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 03/05/2018] [Accepted: 04/30/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Limb-length discrepancy (LLD) in children with congenital lower extremity shortening is constant in proportion from birth to skeletal maturity (known as constant inhibition), but its developmental pattern in utero is unknown. The popular prenatal multiplier method to predict LLD at birth assumes constant inhibition in utero to be true. Verifying the in utero developmental pattern of LLD, and thus confirming the validity of the prenatal multiplier method, is crucial for meaningful prenatal parental counseling. OBJECTIVE To elucidate the in utero developmental pattern of LLD in fetuses with congenital lower extremity shortening. MATERIALS AND METHODS Clinical indications for 3,605 lower extremity radiographs performed on infants (<1 year old) at a large tertiary hospital over a 17-year period were reviewed. Inclusion criteria were (1) diagnosis of congenital lower extremity shortening, (2) bilateral lower limb postnatal radiographs documenting LLD and (3) fetal ultrasound (US) documenting LLD. Available measurements of femoral, tibial and fibular lengths on fetal US and postnatal radiographs were collected. Prenatal and postnatal length ratios of shorter-to-longer bones were calculated and compared. RESULTS Eighteen infants met inclusion criteria. Diagnoses were proximal focal femoral deficiency=4, congenital short femur=2, tibial hemimelia=3, posteromedial tibial bowing=6 and fibular hemimelia=3. The correlations between postnatal and prenatal length ratios were high for the femur, tibia and fibula (R>0.98, P<0.0001). The relative differences in the postnatal and prenatal length ratios of these bones were small (|average|<0.026, standard deviation <0.068). CONCLUSION Our data indicate that the postnatal and prenatal length ratios were equivalent, supporting the constant inhibition pattern of LLD in utero, thus validating the prenatal multiplier method for predicting LLD.
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Affiliation(s)
- Andy Tsai
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.
| | - Tal Laor
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA
| | - Judy A Estroff
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA
- Advanced Fetal Care Center, Boston Children's Hospital, Boston, MA, USA
| | - James R Kasser
- Advanced Fetal Care Center, Boston Children's Hospital, Boston, MA, USA
- Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA
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Makarov MR, Jackson TJ, Smith CM, Jo CH, Birch JG. Timing of Epiphysiodesis to Correct Leg-Length Discrepancy: A Comparison of Prediction Methods. J Bone Joint Surg Am 2018; 100:1217-1222. [PMID: 30020127 DOI: 10.2106/jbjs.17.01380] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to compare the accuracy of different methods used to predict ultimate leg lengths and residual leg-length discrepancy in a group of patients treated with epiphysiodesis at our institution. METHODS Seventy-seven patients with adequate preoperative radiographs, no postoperative complications, and follow-up to skeletal maturity composed the study group. We compared the predicted lengths of both legs and residual leg-length discrepancy at maturity with actual outcomes using the White-Menelaus, Anderson-Green, Moseley, and multiplier methods. RESULTS Skeletal age varied >1 year from chronological age in 61 (26%) of 231 observations, including 19 patients (25%) whose average skeletal age from 3 determinations differed by >1 year from chronological age. The prediction accuracy of each method was improved by using skeletal, rather than chronological, age. Error in prediction of the length of the short leg varied from a mean (and standard deviation) of 1.8 ± 1.2 cm for the straight-line graph to 2.5 ± 2.0 cm for the multiplier method. Prediction error for the long leg (after epiphysiodesis) varied from a mean of 1.2 ± 1.1 cm for the straight-line graph to 1.7 ± 1.5 cm for the multiplier method. Leg-length-discrepancy prediction error ranged from a mean of 0.7 ± 0.6 cm for the White-Menelaus method incorporating a growth inhibition factor to 1.1 ± 0.9 cm for the multiplier method. The multiplier method was the least accurate of all. All differences were significant. CONCLUSIONS Determination of skeletal age is clinically relevant in patients being considered for epiphysiodesis to manage leg-length inequality. The multiplier method was the least accurate of the prediction methods in this patient population, which may have implications in calculating the appropriate timing of epiphysiodesis.
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Affiliation(s)
| | | | - Connor M Smith
- University of Texas Southwestern Medical School, Dallas, Texas
| | - Chan-Hee Jo
- Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - John G Birch
- Texas Scottish Rite Hospital for Children, Dallas, Texas
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Novais EN, Maranho DA, Kim YJ, Kiapour A. Age- and Sex-Specific Morphologic Variations of Capital Femoral Epiphysis Growth in Children and Adolescents Without Hip Disorders. Orthop J Sports Med 2018; 6:2325967118781579. [PMID: 30090833 PMCID: PMC6077912 DOI: 10.1177/2325967118781579] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Understanding the development of the capital femoral epiphysis is essential to identify pathologic variations that may lead to cam morphology. Purpose/Hypothesis: The purpose of this study was to investigate the development of the capital femoral epiphysis during childhood and adolescence, with specific morphologic analysis of the peripheral growth and the metaphyseal surface of the growth plate. We hypothesized that age- and sex-dependent morphologic variations of the peripheral growth (cupping) and surface anatomy (epiphyseal tubercle) of the epiphysis would be evident with increasing age. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Pelvic computed tomography scans of 80 children and adolescents (range, 8-15 years; n = 10 per age group; 50% male), imaged because of suspected appendicitis, were used to reformat the proximal femur. All patients had asymptomatic hips with no signs or history of hip disorder. We measured the peripheral cupping of the epiphysis and the epiphyseal tubercle dimensions from 3-dimensional models. All measurements were normalized to the epiphyseal diameter. The effect of age on these parameters was evaluated by use of linear regression analysis. A 2-way analysis of variance (ANOVA) was used to compare these parameters between males and females. Results: The mean epiphyseal cupping increased with increasing age (R2 = 0.54; P < .001). The mean normalized epiphyseal cupping was consistently higher in the anterior and posterior directions compared with the inferior and superior locations. Male patients aged 10 and 11 years had lower (P = .002) mean epiphyseal cupping compared with female patients of the same age. We observed no difference between male and female participants after 12 years of age (P > .3). The normalized epiphyseal tubercle height (R2 = 0.08; P = .009), width (R2 = 0.13; P = .001), and length (R2 = 0.45; P < .001) decreased with increasing age, with no differences between male and female patients. On average, a 2.6-fold increase was found in epiphyseal cupping from 8 to 15 years of age, whereas normalized tubercle height decreased by 0.4-fold. Conclusion: Peripheral cupping of the epiphysis over the metaphysis increases with age, while the relative epiphyseal tubercle dimensions decrease. Females have an earlier onset of rapid increase in the peripheral cupping compared with males; however, no differences in epiphyseal tubercle dimensions were found between male and female patients. These findings may guide future studies investigating the development of cam morphology, which should consider the surface morphologic characteristics of the capital femoral epiphysis, the growth plate, and the differences in morphologic characteristics according to age and sex.
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Affiliation(s)
- Eduardo N Novais
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Daniel A Maranho
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Biomechanics, Medicine, and Rehabilitation of the Locomotor System, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Young-Jo Kim
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ata Kiapour
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
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Richter DJ, Lyon R, Van Valin S, Liu XC. Current Strategies and Future Directions to Optimize ACL Reconstruction in Adolescent Patients. Front Surg 2018; 5:36. [PMID: 29761106 PMCID: PMC5937439 DOI: 10.3389/fsurg.2018.00036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 04/19/2018] [Indexed: 11/13/2022] Open
Abstract
The incidence of anterior cruciate ligament (ACL) injuries in the pediatric population has risen in recent years. These injuries have historically presented a management dilemma in skeletally immature patients with open physes and significant growth remaining at time of injury. While those nearing skeletal maturity may be treated with traditional, transphyseal adult techniques, these same procedures risk iatrogenic damage to the growth plates and resultant growth disturbances in younger patients with open physes. Moreover, conservative management is non-optimal as significant instabilities of the knee remain. Despite the development of physeal-sparing reconstructive techniques for younger patients, there remains debate over which procedure may be most suitable on a patient to patient basis. Meanwhile, the drivers behind clinical and functional outcomes following ACL reconstruction remain poorly understood. Therefore, current strategies are not yet capable of optimizing surgical ACL reconstruction on an individualized basis with absolute confidence. Instead, aims to improve surgical treatment of ACL tears in skeletally immature patients will rely on additional approaches in the near future. Namely, finite element models have emerged as a tool to model complex knee joint biomechanics. The inclusion of several individualized variables such as bone age, three dimensional geometries around the knee joint, tunnel positioning, and graft tension collectively present a possible means of better understanding and even predicting how to enhance surgical decision-making. Such a tool would serve surgeons in optimizing ACL reconstruction in the skeletally immature individuals, in order to improve clinical outcomes as well as reduce the rate of post-operative complications.
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Affiliation(s)
- Dustin Jon Richter
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Roger Lyon
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States.,Department of Orthopaedic Surgery, Children's Hospital of Wisconsin, Milwaukee, WI, United States
| | - Scott Van Valin
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States.,Department of Orthopaedic Surgery, Children's Hospital of Wisconsin, Milwaukee, WI, United States
| | - Xue-Cheng Liu
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States.,Department of Orthopaedic Surgery, Children's Hospital of Wisconsin, Milwaukee, WI, United States
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The effects of uninvolved side epiphysiodesis for limb length equalization in children with unilateral cerebral palsy: clinical evaluation with the Edinburgh visual gait score. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:977-984. [PMID: 29214458 DOI: 10.1007/s00590-017-2097-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Hemiplegic cerebral palsy patient may present a shorten leg on the hemiplegic side that afflicts negatively the kinematic of the uninvolved limb. Thus, the aim of this study was to investigate the modification of gait kinematic after epiphysiodesis for limb equalization and secondary to verify the prediction of correction. METHODS Skeletally immature hemiplegic patients with a minimum limb leg discrepancy (LLD) of 2.5 cm were treated with epiphysiodesis of the unaffected knee and clinically evaluated with Edinburgh visual gait score (EVGS). Green-Anderson curve was used to predict time decision for correction. RESULTS Ten LLD patients were evaluated with the Edinburgh visual gait score (EVGS) before and after surgery. Mean age was 12.7 years, mean follow-up was 6.7 years, and mean LLD was 3.4 cm before surgery and 1.2 cm at final follow-up. After lower limb equalization surgery, improvement in gait kinematics was observed on both the uninvolved and hemiplegic limb of hemiplegic cerebral palsy patients (p < 0.001). Final correction did not reach expected correction (2.3 vs. 2.8 cm). However, the difference was not statistically significant (p = 0.058). CONCLUSION This is the first study to report improvement on both the uninvolved and hemiplegic limb gait kinematics after limb equalization surgery. Due to the impaired dorsiflexion of the hemiplegic foot, LLD target at the end of growth should range between 0.5 and 1.5 cm.
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Schlégl ÁT, O'Sullivan I, Varga P, Than P, Vermes C. Determination and correlation of lower limb anatomical parameters and bone age during skeletal growth (based on 1005 cases). J Orthop Res 2017; 35:1431-1441. [PMID: 27513720 DOI: 10.1002/jor.23390] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 08/05/2016] [Indexed: 02/04/2023]
Abstract
The aim of this study was to evaluate bone age and its correlation with the lower limbs' developing skeletal anatomy during growth. 1005 children and young adults were evaluated for bone age and 14 different parameters measured on lower-limb reconstructions from radiological examinations carried out with an EOS 2D/3D system in the course of routine orthopedic indicated diagnostic practice. Cervical vertebral morphology evaluation for bone age using the Hassel-Farman method, which describes six stages of maturity, was selected. Intra- and inter-observer reliability tests for this method, and for the EOS 3D reconstructions were performed. Statistical analysis were performed using Spearman correlation, multiple linear regression, and t-test. The intra- and inter-observer reliability of the Hassel-Farman method and the EOS 3D lower-limb reconstruction were found to be excellent. Interestingly one bone age stage could include individuals across a 12.1 year range, and conversely individuals of the same calendar age could be of one of 3.2 different bone age stages. In the prepubertal age groups all six bone stages could be observed. Bone age revealed a stronger relationship, lower standard deviations with groups and proved to be a better discriminating variable than the calendar age by collodiaphyseal angle, femoral, and tibial torsion, femorotibial rotation, and mechanical tibiofemoral angle. Bone age is an indicator of skeletal maturity and may more accurately describe the growth of some lower limb parameters. As a result we suggest the consideration of bone age when evaluating lower-limb biomechanic-anatomical parameters. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1431-1441, 2017.
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Affiliation(s)
- Ádám Tibor Schlégl
- Department of Orthopaedics, Medical School, University of Pécs, Akác str. 1. PC: 7632, Pécs, Hungary
| | - Ian O'Sullivan
- Department of Orthopaedics, Medical School, University of Pécs, Akác str. 1. PC: 7632, Pécs, Hungary
| | - Péter Varga
- Department of Orthopaedics, Medical School, University of Pécs, Akác str. 1. PC: 7632, Pécs, Hungary
| | - Péter Than
- Department of Orthopaedics, Medical School, University of Pécs, Akác str. 1. PC: 7632, Pécs, Hungary
| | - Csaba Vermes
- Department of Orthopaedics, Medical School, University of Pécs, Akác str. 1. PC: 7632, Pécs, Hungary
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Affiliation(s)
- Peter D Fabricant
- 1Pediatric Orthopaedic Surgery Service, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY 2Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts 3Harvard Medical School, Boston, Massachusetts
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Abstract
Dramatic increases in youth competitive athletic activity, early sport specialization, and year-round training and competition, along with increased awareness of anterior cruciate ligament (ACL) injuries in children, have led to a commensurate increase in the frequency of ACL tears in the skeletally immature. Recent understanding of the risks of nonoperative treatment and surgical delay have supported a trend toward early operative treatment. This article discusses treatment strategies for ACL injuries in children and adolescents, and offers our preferred treatment strategy for skeletally immature youth athletes with ACL tears.
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An improved spreadsheet for calculating limb length discrepancy and epiphysiodesis timing using the multiplier method. J Child Orthop 2016; 10:313-9. [PMID: 27357078 PMCID: PMC4940249 DOI: 10.1007/s11832-016-0754-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/14/2016] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The multiplier method is a technique to predict limb length discrepancy (LLD) at maturity in pediatric patients. Various tools have been developed for performing the multiplier calculations to predict LLD and timing of epiphysiodesis. These include multiplier/growth applications (apps) and a spreadsheet which have helped to facilitate LLC calculations in an efficient and easy manner. We have updated the spreadsheet to improve features for making LLD calculations and facilitate pasting data into electronic medical records (EMRs). METHODS Tools currently in use were critically examined for features that limited their function, created possible sources of error or could be more user-friendly. These features were modified and recreated in an improved Excel spreadsheet that uses patient age, sex, limb lengths, and previous lengthening surgeries as inputs to predict LLD at maturity and offer options for timing of epiphysiodesis for both congenital and developmental LLD. Our multiplier spreadsheet function was then compared to manual calculations and other multiplier tools for accuracy and ease of use. RESULTS Our spreadsheet accurately calculates LLD at maturity and timing of epiphysiodesis when compared to other methods. It contains a function to calculate predicted leg lengths after previous lengthenings, and concise single-page worksheets for developmental LLD, congenital LLD, and height prediction. CONCLUSIONS This spreadsheet was developed to provide a more efficient and user-friendly method of calculating LLD at maturity and timing of epiphysiodesis. It can easily be pasted into the EMR for ease of documentation. We recommend this method for both clinical practice and educational use.
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Affiliation(s)
- Christopher Iobst
- Nemours Children's Hospital, 13535 Nemours Parkway, Orlando, FL 32827
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Vogt B, Horter M, Rödl R. [Special topics in pediatric orthopedics: options and limits of growth guidance]. DER ORTHOPADE 2015; 43:714-24. [PMID: 25116240 DOI: 10.1007/s00132-013-2223-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND A main task of pediatric orthopedics is the treatment of legs of different lengths or misshapen legs. Whereas for adult patients complicated and invasive operative interventions are necessary, the growth potential of the epiphysial plate can be utilized in childhood and adolescence to correct leg length differences and leg axis deformities. THERAPY Epiphysiodesis leads to a guidance of growth via a temporary or permanent and partial or complete blockade of the epiphysial plate depending on the indications. This method is principally a less invasive procedure with few complications. CONCLUSION Careful preoperative assessment of the indications and planning, precise operative technique and attentive postoperative control investigations are absolutely essential for successful treatment.
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Affiliation(s)
- B Vogt
- Abteilung für Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland,
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