Lower Extremity Length Research Articles

Incidence and biomechanical risk factors for running-related injuries: A prospective cohort study

BackgroundInjuries among runners is significant, yet the contributing risk factors remain elusive. The objective of this study was to examined the incidence and biomechanical elements associated with running-related injuries. MethodsA 24-week prospective study was carried out. Injury incidence was calculated per 1000 h of running, with participants completing bi-monthly online questionnaires. Biomechanical risk factors, encompassing plantar pressure, muscle strength of hip and knee muscles, core stability, dorsiflexion, passive hip internal rotation, lower extremity length, Q-angle, and shank-forefoot alignment, were assessed at baseline. Logistic regression was used to investigate the relationship between injury incidence and these biomechanical risk factors. ResultsNinety-eight runners participated in the study. Injury incidence was 8.1 per 1000 h of running, with 41 runners experiencing musculoskeletal injuries during the follow-up period. The knee emerged as the most commonly affected joint, constituting 28.4 % of injuries. The Odds Ratio for hip external rotator muscle strength was .84 (95 % Confidence Interval = .71 - .99). ConclusionGreater force during hip external rotation was identified as a protective factor against running injuries. These findings bear significance for the formulation and implementation of preventive strategies.

Investigation of the relationship between hallux valgus, quadriceps angle, and body image perception in young adults

Purpose: Our study aimed to identify the presence and severity of hallux valgus deformity in young adults, using both by the Manchester classification and goniometry, to evaluate the Quadriceps angle (Q angle), and to examine the relationship between some anatomical parameters and body image perception. Materials and Methods: A total of 158 individuals aged 18-30 (111 females, 47 males) who voluntarily agreed to participate in the study were included. Demographic characteristics, Quadriceps angle, and hallux valgus angle were measured. Hallux valgus and Quadriceps angles were determined using a goniometer, while the Manchester scale was employed to evaluate the level of Hallux valgus deformity. The Golden Ratio for the lower extremity was calculated by taking the ratio of lower extremity length to leg length, and the body image perception score was determined. Results: Body weight, height and body mass index showed statistically significant differences in terms of gender, while age parameter did not show statistically significant difference between genders. Also, no significant difference in Quadriceps angle was observed between genders for both right and left sides, while a significant difference in Hallux valgus angle was noted. A high, positive, and significant relationship was found between Manchester classification and hallux valgus, while Golden ratio values did not significantly differ by gender. Additionally, body image perception scores were higher in males (162.60±25.45 points) than in females (153.51±25.89 points). Conclusion: Deviations from their normal values of the hallux valgus and quadriceps angle which affect the musculoskeletal system, may lead to some health problems, as well as difficulties in performing daily life activities, and concerns about aesthetics. Failure to fulfil one’s normal functions or not to find oneself aesthetically insufficient will also make it likely that the body image perception will deteriorate.

Lower Extremity Growth according to AI Automated Femorotibial Length Measurement on Slot-Scanning Radiographs in Pediatric Patients.

Background Commonly used pediatric lower extremity growth standards are based on small, dated data sets. Artificial intelligence (AI) enables creation of updated growth standards. Purpose To train an AI model using standing slot-scanning radiographs in a racially diverse data set of pediatric patients to measure lower extremity length and to compare expected growth curves derived using AI measurements to those of the conventional Anderson-Green method. Materials and Methods This retrospective study included pediatric patients aged 0-21 years who underwent at least two slot-scanning radiographs in routine clinical care between August 2015 and February 2022. A Mask Region-based Convolutional Neural Network was trained to segment the femur and tibia on radiographs and measure total leg, femoral, and tibial length; accuracy was assessed with mean absolute error. AI measurements were used to create quantile polynomial regression femoral and tibial growth curves, which were compared with the growth curves of the Anderson-Green method for coverage based on the central 90% of the estimated growth distribution. Results In total, 1874 examinations in 523 patients (mean age, 12.7 years ± 2.8 [SD]; 349 female patients) were included; 40% of patients self-identified as White and not Hispanic or Latino, and the remaining 60% self-identified as belonging to a different racial or ethnic group. The AI measurement training, validation, and internal test sets included 114, 25, and 64 examinations, respectively. The mean absolute errors of AI measurements of the femur, tibia, and lower extremity in the test data set were 0.25, 0.27, and 0.33 cm, respectively. All 1874 examinations were used to generate growth curves. AI growth curves more accurately represented lower extremity growth in an external test set (n = 154 examinations) than the Anderson-Green method (90% coverage probability: 86.7% [95% CI: 82.9, 90.5] for AI model vs 73.4% [95% CI: 68.4, 78.3] for Anderson-Green method; χ2 test, P < .001). Conclusion Lower extremity growth curves derived from AI measurements on standing slot-scanning radiographs from a diverse pediatric data set enabled more accurate prediction of pediatric growth. © RSNA, 2024 Supplemental material is available for this article.

Optimizing calibration of modern skeletal maturity systems.

Greulich and Pyle is the most used system to estimate skeletal maturity but has significant drawbacks, prompting the development of newer skeletal maturity systems, such as the modified Fels skeletal maturity systems based on knee radiographs. To create a new skeletal maturity system, an outcome variable, termed a "skeletal maturity standard," must be selected for calibration of the system. Peak height velocity and 90% of final height are both considered reasonable skeletal maturity standards for skeletal maturity system development. We sought to answer two questions: (1) Does a skeletal maturity system developed using 90% of final height estimate skeletal age as well as it would if it was instead developed using peak height velocity? (2) Does a skeletal maturity system developed using 90% of final height perform as well in lower extremity length prediction as it would if it was instead developed using peak height velocity? The modified Fels knee skeletal maturity system was recalibrated based on 90% of final height and peak height velocity skeletal maturity standards. These models were applied to 133 serially obtained, peripubertal antero-posterior knee radiographs collected from 38 subjects. Each model was used to estimate the skeletal age of each radiograph. Skeletal age estimates were also used to predict each patient's ultimate femoral and tibial length using the White-Menelaus method. The skeletal maturity system calibrated with 90% of final height produced more accurate skeletal age estimates than the same skeletal maturity system calibrated with peak height velocity (p < 0.05). The 90% of final height and peak height velocity models made similar femoral and tibial length predictions (p > 0.05). Using the 90% of final height skeletal maturity standard allows for simpler skeletal maturity system development than peak height velocity with potentially more accuracy.

Study of height, sitting height, lower extremity length, and the prevalence of short stature among elementary school students in the Tianyuan District of Zhuzhou City.

In this study, the height, sitting height, lower extremity length, growth status, and body proportions of elementary school students aged 6 to 12 years in Tianyuan District of Zhuzhou City, China, were analyzed. A total of 41,156 children from 38 elementary schools in the Tianyuan District of Zhuzhou City were selected for height measurement, employing the cluster sampling method. After the cluster data were obtained, the height and sitting height information were extracted, and calculations were performed for lower extremity length, sitting height-to-lower extremity length ratio, and sitting height-to-height ratio. Statistical analysis was conducted using SPSS 23.0 software. The height and sitting height measurements of boys and girls aged 6 to 12 years in Tianyuan District surpassed the 2005 national standard set for 9 cities, while the lower extremities of children within the 7 to 9 age range fell below the national standard. In alignment with the national average, the fitted curve representing height for both boys and girls aged 6 to 12 years in Tianyuan District exhibited an intersection point around 10 to 10.5 years. No discernible distinction was observed in the incidence of short stature, as analyzed through the P3 standard, between the fitted curve for Tianyuan District and the national standard. Moreover, tall children exhibited a significantly lower sitting height-to-height ratio compared to their shorter counterparts. The fitted height curve in Tianyuan District, Zhuzhou City, proves effective in discerning shorter-statured children within the region. Nevertheless, further research is warranted to elucidate the factors contributing to the comparatively shorter lower extremities observed in children from Tianyuan District, Zhuzhou City, in contrast to the national average.

Normative values and factors affecting Pediatric Reach Tests in Saudi children aged 6-11 years in the eastern province: cross-sectional study.

The Pediatric Reach Tests (PRTs) assess balance while standing-the Functional Reach Test (FRT) and Lateral Reach Test (LRT)-and in a sitting position-the Modified Functional Reach Test (MFRT) and Modified Lateral Reach Test (MLRT). Normative values have not been fully evaluated in Saudi children. The objectives are; to estimate the normative values for PRTs; investigate the correlation between the PRTs and demographic/anthropometric characteristics; and develop predictive equations for the PRTs. In this cross-sectional study, 251 children aged 6-11 were recruited. The PRTs were measured and correlated with demographic/anthropometric variables. A stepwise regression was conducted to develop the predictive equations for the PRT scores. The mean and standard deviations (in cm) of the PRT scores were as follows: FRT = 20.02 ± 4.31; LRT = 13.42 ± 3.38; MFRT = 21.49 ± 4.70, and MLRT = 14.64 ± 3.66. Several significant correlations were found. Moderate correlations existed between the PRT scores and age, height, upper extremity length, lower extremity length, and foot length; there was a weak correlation with body mass index. Weight was moderately correlated with FRT and MFRT and weakly correlated with LRT and MLRT. The correlation between the base of support and LRT was moderate and was weak with FRT, MFRT, and MLRT. A weak correlation was found between sex and LRT. Age and height were the most predictive of PRT scores. This study provided PRT normative values that can be used as a clinical reference for evaluating balance in typically developing children.

The Reliability of the Modified Fels Knee Skeletal Maturity System.

The recently described Modified Fels knee skeletal maturity system (mFels) has proven utility in prediction of ultimate lower extremity length in modern pediatric patients. mFels users evaluate chronological age, sex, and 7 anteroposterior knee radiographic parameters to produce a skeletal age estimate. We developed a free mobile application to minimize the learning curve of mFels radiographic parameter evaluation. We sought to identify the reliability of mFels for new users. Five pediatric orthopaedic surgeons, 5 orthopaedic surgery residents, 3 pediatric orthopaedic nurse practitioners, and 5 medical students completely naïve to mFels each evaluated a set of 20 pediatric anteroposterior knee radiographs with the assistance of the (What's the Skeletal Maturity?) mobile application. They were not provided any guidance beyond the instructions and examples embedded in the app. The results of their radiographic evaluations and skeletal age estimates were compared with those of the mFels app developers. Averaging across participant groups, inter-rater reliability for each mFels parameter ranged from 0.73 to 0.91. Inter-rater reliability of skeletal age estimates was 0.98. Regardless of group, steady proficiency was reached by the seventh radiograph measured. mFels is a reliable means of skeletal maturity evaluation. No special instruction is necessary for first time users at any level to utilize the (What's the Skeletal Maturity?) mobile application, and proficiency in skeletal age estimation is obtained by the seventh radiograph. Level II.

Patient perception of leg length after total hip arthroplasty does not correlate with sagittal lumbar spine stiffness, history of spinal pathology or fusion.

Although spinal pathology or fusion can change patients' posture and pelvic orientation, their correlation with perception of limb length discrepancy (LLD) after total hip arthroplasty (THA) is not well understood. We hypothesised that LLD perception after THA would not correlate with a history of spinal pathology, fusion or sagittal lumbar spine stiffness among patients who underwent THA. Four hundred consecutive patients who underwent THA and had a complete set of anteroposterior and lateral EOS® imaging in standing and sitting positions were included in this retrospective case-control study. All patients underwent THA between 2011 and 2020. Sagittal lumbar spine stiffness was measured by changes in lumbar lordosis and sacral slope from the standing to the sitting position (lumbar spine stiffness: standing sacral slope-sitting sacral slope < 10°). Anatomical and functional lower extremity length, change in the centre of hip rotation, coronal and sagittal knee alignment, and hindfoot height were measured. Multiple logistic regression was used to investigate the correlation between patient perceptions of LLD, and the variables found to be significant in the univariate analysis. There was a substantial difference between the patients with and without LLD perceptions regarding axial pelvic rotation (p = 0.001), knee flexum-recurvatum (p = 0.007) and hindfoot height (p = 0.004). There was no significant difference between patients with and without LLD perceptions regarding differences in femoral length (p = 0.06), history of spine pathology or fusion (p = 0.128) and lumbar spine stiffness (p = 0.955). Our study found no significant correlation between perceptions of LLD after THA and spinal fusion or lumbar spine stiffness. Changes in the position of the centre of hip rotation can affect the functional leg length. Surgeons should consult patients regarding other factors, such as knee alignment or hind-/midfoot pathologies, as well as compensatory mechanisms, such as axial pelvic rotation, that could affect perceptions of LLD.

Correlations between one-repetition maximum weights of different back squat depths

BACKGROUND: Although squat depth determines the weight that can be lifted while squatting, it is unclear whether the one-repetition maximum (1RM) at one squat depth can be used to estimate the 1RM at another squat depth. OBJECTIVE: To determine the correlations between 1RM weights at different back squat (BSQ) depths in frequently trained male collegiate athletes. METHODS: This cross-sectional study included 26 male collegiate athletes. Body composition, lower extremity length, and 1RM of BSQ were measured. 1RM of BSQ was measured at three positions (quarter, half and parallel positions), defined as 45 degrees of knee flexion (quarter, Q-SQ), 90 degrees of knee flexion (half, H-SQ), and femur parallel to the ground (parallel, P-SQ), respectively. All testing was conducted by a certified strength and conditioning specialist. Pearson’s correlation analysis and Spearman’s rank correlation were used to examine the correlation between 1RM at each squat depth. RESULTS: There was a significant correlation between 1RM in the H-SQ and P-SQ positions (p&lt; 0.001, r= 0.725, R2= 0.526, y= 1.0728x+ 24.641), but no significant correlation between 1RM of Q-SQ and P-SQ, and 1RM of Q-SQ and H-SQ. There were significant correlations between the 1RM/BW of Q-SQ and height (p= 0.001, r= 0.594), and with the length of the lower extremities (p= 0.002, r= 0.586). CONCLUSIONS: Mutual estimation of the 1RM of H-SQ or P-SQ from the 1RM of the other squat position is possible. Estimation of the 1RM of Q-SQ from the 1RM of H-SQ or P-SQ is, however, difficult, and must be measured separately. Future studies should be conducted with larger sample sizes, in athletes of various sports, and in females.

Patellofemoral Angle, Pelvis Diameter, Foot Posture Index, and Single Leg Hop in Post-Operative ACL Reconstruction.

Background and Objectives: Anterior cruciate ligament (ACL) injuries occur as a result of the deterioration of the static and dynamic stability of the knee. One of the structures involved in providing static stability is the patellofemoral angle (Q angle). The aim of this study was to investigate the relationships between Q angle, pelvis diameter, lower extremity length, and foot posture index (FPI) in patients who had undergone ACL reconstruction (ACLR) with the semitendinosus/gracilis (ST/G) technique on both the operated and non-operated sides. Materials and Methods: Twenty-five male recreational athletic patients between the ages of 18 and 35 who had undergone semitendinosus/gracilis (ST/G) anterior cruciate ligament reconstruction at least 6 months earlier were included in the study. Femur length, lower extremity length, pelvis diameter, and Q angle measurements, total foot posture index (FPI) scores, and single leg hop (SLH) and triple hop distance (THD) test results were determined on the operated and non-operated sides. Results: When the findings of the patients were evaluated statistically between the operated and non-operated sides, no significant differences were found in Q angle, femur length, and lower extremity length (p > 0.05). In terms of FPI scores, a significant difference was found only in the inversion/eversion of the calcaneus (CALC) parameter (p < 0.05). When the single hop test (SLHT) results were evaluated statistically on the operated and non-operated sides, the results were in favor of the non-operated side (p < 0.05). In the correlation analysis conducted for both the operated and non-operated sides, positive and significant correlations were found only between SLH and THD (p < 0.05). No significant difference was found in the other parameters. Conclusions: The fact that ST/G ACLR 6th month post-operative findings revealed similar results in Q angle, lower extremity length, and total FPI scores between the operated and non-operated sides showed that the 6-month process did not cause a difference in these parameters. However, it was found that the operated sides showed lower findings compared to non-operated sides for SLHTs, although these findings were within normal ranges in terms of the limb symmetry index.

Repercussions of Consanguinity on Metrical Traits At Different Phases of Growth

Introduction: Consanguinity is associated with increase in the likelihood of receiving two copies of deleterious gene from parents, which brings the hidden recessive disorders. This further increases the risk of neonatal and post neonatal mortality. Some of which may also have negative effect on metrical traits of the children, thereby affecting their development and reducing their cognitive abilities. Aim: To examine the effect of parental consanguinity on various metrical traits like linear, circumferential and weight measurements among the Muslim males. Materials and Methods: A cross-sectional study was conducted amongst the Muslim males living in the different river islands of Barpeta district in Assam. The study consisted 1438 males (587 inbred and 851 non-inbred). A total of 936 boys (3 years to 18 years) were measured at an interval of one year. The rest (502 adult men) from 19 to 60 years were in age cohorts of five-years age interval. They were measured for stature, sitting height, lower extremity length, body weight, waist circumference, abdominal circumference and hip circumference. Inbreeding depression on trait was calculated using average coefficient of inbreeding and % of depression in a trait. Wright’s path coefficient method was used for the calculation of inbreeding coefficient. Results: The average coefficient of inbreeding was found to be 0.01637931154. A significant increase in the difference of mean values in all the linear, circumferential and weight measurements has been observed at many ages with the increase in the inbreeding coefficient during childhood and adolescence phase of life. But the difference in mean variance in the adult body parameters between the inbred and non-inbred was statistically insignificant at almost all ages (p&gt;0.05). Conclusion: Consanguinity has not affected any of the adult body measurements. A significant positive association between consanguinity and diminution of body measurements found during the growing period needs to be correlated with the other socio demographic variables because the growing period is always more dependent on environmental variables.

ANTHROPOMETRIC MODELING OF LOWER EXTREMITIES LENGTH OF STUDENTS OF HIGHER EDUCATION INSTITUTIONS DEPENDING ON THE SPORT TYPE

Taking into account the literature, further establishment of anthropometric parameters according to individual sports, followed by building a model to solve problems of selection and sports orientation is relevant and necessary in modern sports Creating the model based on anthropometric parameters will allow us to coduct sports selection among future athletes in order to achieve excellent results in professional sports. The objective of the study was to fi nd out the features of the length of the lower extremities depending on the sport type, followed by building a model for predicting their length.А comparative analysis of anthropometric parameters of the lengths of the lower extremities depending on the sport on 129 students of higher education, aged 16 to 18 years, who were divided into main – 89 (69%) and control group – 40 (31%), followed by model building predicting their length of the lower extremities. The length of the right lower extremities of the studied students of the main group is: volleyball – 91.72±3.0 cm; football – 90.02±3.0 cm; basketball – 89.42±3.0 cm; wrestling – 89.80±3.0 cm; tennis – 89.60±3.0 cm; wrestling – 89.80±3.0 cm; fi tness – 86.55±2.0 cm. Students in the control group, the average length of the right lower extremities is – 85.90±2.0 cm. The length of the left lower extremities of the studied students of the main group is: volleyball – 91.38±3.0 cm; football – 89.72±3.0 cm; basketball – 89.57±3.0 cm; wrestling – 89.40±3.0 cm; tennis – 89.20±3.0 cm; fi tness – 86.66±2.0 cm. Students in the control group, the average length of the left lower extremities is – 85.72±2.0 cm.Anthropometric study (length of the lower extremities) was performed according to the method of VV Bunak in the modifi cation of PP Shaparenko. Statistical analysis of the data was performed using a licensed program RStudio.Comparing the length of the right lower extremity depending on the sport found a signifi cant diff erence in the length of the right lower extremity in the pairs «football»-»fi tness», «volleyball»-»fi tness», «football»-»control group», «volleyball»-»control group», comparing the length of the left lower limb in pairs «volleyball»- »fi tness», «football»-»control group», «volleyball»-»control group». No signifi cant diff erence in the average length of the right and left upper extremities of both study groups was found (main group – 89.51±3.0 cm – right, 89.32±3.0 cm – left; control – 85.90±3.0 cm – right, 85.72±3.0 cm – left).It was found that a signifi cant factor for the length of both lower extremities is growth (based on regression analysis). Based on this, a model for predicting the length of the lower extremities is derived: L = 0.422 x h, (where L is the length of the upper extremity, h is the height).

A novel method of manual positioning based on anatomical mark (shoulder-to-shoulder) to prevent postoperative leg-length discrepancy for femoral neck fractures in hip arthroplasty.

To determine whether the two lower extremities are of equal length after hip arthroplasty for femoral neck fractures, we developed a novel method of manual positioning based on anatomical mark (shoulder-to-shoulder) in hip arthroplasty. Patients with femoral neck fractures requiring hip arthroplasty from July 2020 to March 2022 in the orthopedic department of Jinjiang Municipal Hospital, Fujian Province, China were recruited. Hip arthroplasty was performed using the proposed "shoulder-to-shoulder" method of manual positioning based on anatomical mark in 52 patients with femoral neck fractures who met the inclusion criteria. "Shoulder-to-shoulder" was achieved by alignment of the marked femoral "shoulder" and the "shoulder" of prosthesis stem. There were 16 male and 36 female patients, with 27 undergoing total hip arthroplasty (THA) and 25 undergoing hip hemiarthroplasty (HA). The fractures were categorized according to the Garden classification: type II, type III, and type IV in 5, 11, and 36 patients, respectively. The vertical distance from the apex of the medial margin of the femoral trochanter to the tear drop line on both sides which was regarded as the length of both limbs were compared via postoperative imaging, and the apex-shoulder distance on the ipsilateral side measured via postoperative imaging was compared with those measured intraoperatively. All patients completed the surgery successfully. The measurement results for the lower extremities after THA were as follows: contralateral group, 43.87 ± 5.59 mm; ipsilateral group, 44.64 ± 5.43 mm. The measurement results for the lower extremities after HA were as follows: contralateral group, 45.18 ± 7.82 mm; ipsilateral group, 45.16 ± 6.43 mm. The measurement results for the lower extremities after all arthroplasties were as follows: contralateral group, 44.50 ± 6.72 mm; ipsilateral group, 44.89 ± 5.90 mm. The results for the apex-shoulder distance were as follows: postoperative imaging, 19.44 ± 3.54 mm; intraoperative apex-shoulder distance, 27.28 ± 2.84 mm. Statistical analysis results indicated no statistically significant difference in the postoperative bilateral lower extremity length after hip arthroplasty (P = 0.75), while a statistically significant difference was found between the intraoperative and postoperative imaging measurements of the apex-shoulder distance (P < 0.01). The novel method of manual positioning based on anatomical mark (shoulder-to-shoulder) for femoral neck fractures in hip arthroplasty is simple and accurate, making it effective for preventing postoperative bilateral leg length discrepancy.

Does the technique of limb lengthening affect physeal growth in patient with achondroplasia? Comparison of the simultaneous and consecutive tibia and femur lengthening with external fixators.

We aimed to retrospectively investigate and compare patients who underwent bilateral simultaneous and consecutive lengthening surgery of the femur and tibia in terms of the effect on physeal growth. We hypothesize that compared with the sequential lengthening technique, simultaneous lengthening of the bilateral femur and tibia affects physeal growth to a greater extent. Twenty-six patients with achondroplasia who operated in our clinic between 1995 and 2015 for limb lengthening were included in the study. Fourteen patients with bilateral lengthening of the femur and tibia at the same time were named as simultaneous bilateral lengthening (SBL). Twelve patients with bilateral lengthening of the femur and then bilateral tibia lengthening in other sections or vice versa, at a different time was named consecutive bilateral lengthening (CBL). All patients were followed until at least 18 years old. The physeal arrest was measured with predicted final length at the first visit (investigated with the multiplier method), the total amount of lengthening, and final clinical, and radiological length. Mean limb lengthening was 145 mm (48.5%) and 151 mm (46.6%) for simultaneous and consecutive groups respectively. For lower extremity length, the first group reached 527.6 mm while the expected was 447.3 mm. Considering 151 mm lengthening, the mean growth disturbance for the SBL group was 70.7 mm and for the CBL group was 47.5 mm. For total height comparing between two groups, disturbance for height was 80.5 mm and 65.4 mm, respectively. Although there was no statistical difference, simultaneous bilateral femoral and tibial lengthening has more physiological physeal disturbance effects than consecutive lengthening in patients with achondroplasia.

Femur Length is Correlated with Isometric Quadriceps Strength in Post-Operative Patients.

BACKGROUNDFew existing studies have examined the relationship between lower extremity bone length and quadriceps strength.PURPOSE/HYPOTHESISTo evaluate the relationship between lower extremity, tibia and femur lengths, and isometric quadriceps strength in patients undergoing knee surgery. The null hypothesis was that there would be no correlation between lower extremity length and isometric quadriceps strength.STUDY DESIGNCross-sectional studyMETHODSPatients with full-length weightbearing radiographs that underwent isometric quadriceps strength testing after knee surgery were included. Using full-length weightbearing radiographs, limb length was measured from the ASIS to the medial malleolus; femur length was measured from the center of the femoral head to the joint line; tibia length was measured from the center of the plateau to the center of the plafond. Isometric quadriceps strength was measured using an isokinetic dynamometer. Pearson’s correlation coefficient was used to report the correlation between radiographic limb length measurements. A Bonferroni correction was utilized to reduce the probability of a Type 1 error.RESULTSForty patients (26 males, 14 females) with an average age of 25.8 years were included. The average limb, femur, and tibia lengths were not significantly different between operative and non-operative limbs (p>0.05). At an average of 5.8±2.5 months postoperatively, the peak torque (156.6 vs. 225.1 Nm), average peak torque (151.6 vs. 216.7 Nm), and peak torque to bodyweight (2.01 vs 2.89 Nm/Kg) were significantly greater in the non-surgical limb (p<0.01). Among ligament reconstructions there was a significant negative correlation between both limb length and strength deficit (r= -0.47, p=0.03) and femur length and strength deficit (r= -0.51, p=0.02). The average strength deficit was 29.6% among the entire study population; the average strength deficit was 37.7% among knee ligament reconstructions. For the non-surgical limb, femur length was significantly correlated with peak torque (r = 0.43, p = 0.048).CONCLUSIONFemur length was significantly correlated with the isometric quadriceps peak torque for non-surgical limbs. Additionally, femur length and limb length were found to be negatively correlated with quadriceps strength deficit among ligament reconstruction patients. A combination of morphological features and objective performance metrics should be considered when developing individualized rehabilitation and strength programs.

The Comparison of Lower Extremity Length and Angle between Computed Radiography-Based Teleoroentgenogram and EOS® Imaging System.

Background and objectives: The differences between computed radiography-based teleoroentgenograms (CR-based teleoroentgenograms) and an EOS® imaging system were evaluated by measuring lower extremity lengths and alignments. Materials and methods: The leg length [L], femur length [F], tibia length [T], and hip–knee–ankle (HKA) angle were measured in 101 patients with lower extremity disease by a CR-based teleoroentgenogram with computed radiography and an EOS®. The additive length of the femoral and tibial segments (F + T) was determined by adding the two length values. Then, the differences among all five parameters between the two techniques were analyzed. The magnification (mm) was calculated by subtracting the length measurements on the EOS® from those in the scanogram. Furthermore, the magnification percentage (%) was calculated by dividing the magnification with the measurements on the EOS®. Results: The magnification errors (mean ± standard deviation), when comparing both right and left sides, were 7.80 ± 1.41%, 7.3 ± 6.01%, 5.16 ± 1.25%, and 6.45 ± 0.94% for L, F, T, and F + T, respectively. For limb length, the CR-based teleoroentgenogram had an average magnification of 6.8% (range, 5.2 to 7.8%) compared to the EOS® imaging. The two groups displayed a statistical difference (p < 0.01), except for the HKA angle. Conclusions: The CR-based teleoroentgenogram had a magnification of about 6.8% compared to the EOS® imaging system in evaluating lower extremity length. Therefore, more attention must be given to CR-based teleoroentgenograms to correct angular deformities.

The Utility of the Modified Fels Knee Skeletal Maturity System in Limb Length Prediction.

Predicting ultimate lower extremity length is important in the treatment of lower limb length discrepancy (LLD), congenital limb deficiency, and other etiologies. Utilizing skeletal age over chronological age improves the prediction of ultimate lower extremity length. The recently described modified Fels knee skeletal maturity system allows for skeletal age estimation via imaging always available in LLD patients. We sought to compare the accuracy of the modified Fels knee skeletal maturity system versus chronological age in ultimate limb length prediction of a modern adolescent clinical population. The medical records of all patients treated at our institution over a 20-year period with unilateral lower extremity pathology and available lower extremity imaging before and after reaching skeletal maturity were reviewed. Skeletal maturity was defined radiographically by closed distal femoral, proximal tibial, and proximal fibular physes. The femoral, tibial, and lower extremity length was measured in all radiographs. The modified Fels knee skeletal maturity system was applied to all radiographs obtained before maturity to estimate skeletal age. The accuracy of 3 widely utilized lower extremity length prediction systems was compared when utilizing estimated Fels skeletal age versus chronological age inputs. A total of 245 radiographs (109 before maturity) from 43 patients were eligible for inclusion. On cross-sectional analysis, linear modeling using Fels skeletal ages was uniformly associated with higher (improved) R2 values than chronological age-based models. On longitudinal analysis, skeletal age mixed-effects models had significantly lower (improved) Akaike information criterion and Bayesian information criterion values than chronological age models in all cases. Cohen d values were also significantly different (P<0.05) for the skeletal age models compared with chronological age models in all cases. In the treatment of LLD, the modified Fels knee skeletal maturity system can be readily applied to available imaging to improve the prediction of ultimate femoral, tibial, and lower extremity length. This skeletal maturity system may have significant utility in the estimation of ultimate LLD and determination of appropriate timing of epiphysiodesis. Level III.

Radiological evaluation of the relationship between femoral head rotation center and trochanter major

Purpose: We aimed to investigate the distance between the tip of Trochanter Major (TTM) and the Femoral Head Rotation Center (FHC) and investigate other measurements on orthoroentgenograms obtained in the local population. Materials and methods: Patients aged 18 and over who were admitted to the hospital between 2 June 2020 and December 2020 and had an orthoroentgenogram were included in the study. Patients with hip joint degeneration, deformities, bone dysplasia, bone tumors, bone tissue irregularities, old fractures or surgical findings, and those with lower extremity length discrepancies were excluded from the study. The tip of trochanter major - The femoral head rotation center (TMFH) distance, collodiaphyseal angle, femur length, and femoral head area were measured on the orthoroentgenogram. Radiological measurements were made by two orthopedic specialists who participated in the study. In addition, the age and gender of the patients and the side of the femur evaluated were recorded. Results: When evaluated according to gender, it was observed that the femoral length of the males was approximately 35.37 ± 5.6+3 mm longer than that of the females, and the femoral head area was 3 ± 1.4 cm2 larger compared to the females (Table 1). These differences between the genders were considered statistically significant (&lt;0.001). The mean collodiaphyseal (CD) angle of 180 femurs included in the study was 131.9o ± 5.2o,the TMFH distance was measured as 4.77 ± 5.0 mm, the tip of trochanter major was above the femoral head rotation center. There was no statistically significant difference in this distance in terms of gender and mean right/left side measurements. Conclusions: The relationship between the femoral head rotation center (FHC) and the tip of the trochanter major (TTM) is a viable method in determining the lower extremity length. While evaluating this relationship, the values of the nonaffected contralateral hip can be used. However, if any deformity in the contralateral hip occurs, measurements obtained in the local population could be helpful in providing information about appropriate leg length. Keywords: Hip reconstruction, anthropometry, proximal femoral anatomy, femoral head rotation center, trochanter major ________________________________________________________________

Characteristics of inhomogeneous lower extremity growth and development in early childhood: a cross-sectional study

BackgroundEarly 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.MethodsA 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.ResultsAll 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).ConclusionsRelative 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.

Prevalence of Football Injuries in Egyptian Children and Adolescents and its Correlation To Anthropometric Parameters

Purpose the study aims to survey the prevalence and incidence of football injuries at the age group from (10-15) years old, correlate the injuries to anthropometric measurements as body and the height and correlate injuries to the player's position in the field. Methods 100 players were randomly selected their history of injuries and their positions were recorded and 12 measurements (weight, height, sitting height, lower extremity length, thigh length, arm length, head, waist, upper arm, thigh and calf circumferences and BMI were calculated. Results 23% players had been injured for only one injury within the recorded two seasons, 12% players and 5% players had been injured for two times and three times respectively. with incidence 32% and prevalence 21%. Spearman’s rho correlation was tested between the player position and injury both recent and previous. A moderate positive correlation (0.3-0.7) was found between the player position and both total and recent injuries with no significant correlation between the player position and their previous injuries. No significant correlation between the anthropometric measurements and injuries. Conclusion players at (10-15) years old are highly suspected for injuries especially fractures, most of those injuries are contact injuries which occurs during the match. Anthropometric measurements cannot be used to predict the incidence of injuries. Defenders were the highly suspected for injuries.