EOS Imaging of Scoliosis, Leg Length Discrepancy and Alignment

Leg length discrepancies (LLD): An etiology to be considered in its proper measure. A critical and historical review

INTRODUCTION

Studies of leg-length discrepancies (LLD) have been the subject of debate for almost 200 years. A large number of studies have emerged, most frequently using assessment criteria based on painful symptoms or joint damage.

DEVELOPMENT

While many authors argue for a threshold of 10-20 mm to establish a link between pain and LLD, most publications based on radiography show lesion stigmata on lumbar, hip and knee joints as early as 6 mm. This would be linked to comorbidities.

DISCUSSION

Some studies argue forcefully that leg-length correction below 20 mm is of no benefit. The authors of the present article, on the other hand, evoke the notion of lesion risks in the absence of correction, even for small deviations in the presence of certain associated factors and according to their importance.

CONCLUSION

The authors argue for the need to define in the future a lesion significance score that would not be correlated to painful symptomatology, but rather to the presence of co-morbidities such as age, anatomical variability, sports practice and/or patients' professional activities. Other parameters, such as mobility, should also be taken into consideration, while gender, height and weight do not appear to be significantly related.

Quantitative Skeletal Imaging and Image-Based Modeling in Pediatric Orthopaedics

PURPOSE OF REVIEW

Musculoskeletal imaging serves a critical role in clinical care and orthopaedic research. Image-based modeling is also gaining traction as a useful tool in understanding skeletal morphology and mechanics. However, there are fewer studies on advanced imaging and modeling in pediatric populations. The purpose of this review is to provide an overview of recent literature on skeletal imaging modalities and modeling techniques with a special emphasis on current and future uses in pediatric research and clinical care.

RECENT FINDINGS

While many principles of imaging and 3D modeling are relevant across the lifespan, there are special considerations for pediatric musculoskeletal imaging and fewer studies of 3D skeletal modeling in pediatric populations. Improved understanding of bone morphology and growth during childhood in healthy and pathologic patients may provide new insight into the pathophysiology of pediatric-onset skeletal diseases and the biomechanics of bone development. Clinical translation of 3D modeling tools developed in orthopaedic research is limited by the requirement for manual image segmentation and the resources needed for segmentation, modeling, and analysis. This paper highlights the current and future uses of common musculoskeletal imaging modalities and 3D modeling techniques in pediatric orthopaedic clinical care and research.