[Differential diagnosis of lateral cystic lesions in the knee joint]. / Térdközeli lateralis cystosus elváltozások differenciáldiagnosztikája.

Soft tissues detected on the lateral side of the knee joint may have differential diagnostic difficulties. Although most of these are benign, mostly cystic in appearance, they may raise the clinical suspicion of tumors due to their increased growth. The authors describe two rare soft tissue changes in three patients. They review the diagnostic procedures most commonly used in daily care, present surgical options, and discuss the literature of the subject. Orv Hetil. 2019; 160(15): 593-599.

Three dimensional radiological imaging of normal lower-limb alignment in children.

PURPOSE: Our study aimed at evaluating age- and gender-specific references describing lower-limb alignment in a large population of children using an accurate and reliable method (EOS 2D/3D). METHODS: From our database, we selected 523 EOS records suitable for 3D modelling representing age groups between two and 16 years in which no relevant deviation influencing lower-limb biomechanics could be observed (the majority of the examined population had mild scoliosis). We performed reconstruction of both lower limbs, thus obtaining the value of the mechanical tibiofemoral angle (mTFA) and the femoral mechanical axis-femoral shaft angle (FM-FS) and calculated the anatomical tibiofemoral angle (aTFA) from previous parameters. Statistical analysis was carried out using the Kolmogorov-Smirnov test, Spearman correlation, regression analysis and Welch test. RESULTS: The aTFA reaches its maximum by the age of three years: 13.07° in boys and 10.73° in girls; it then varies ∼4.44° in both genders. By the age of three years, the mTFA reaches 8.04° in boys and 4.85° in girls; it starts to decrease to -1.47° in boys and 0.13° in girls. By the age of three years, FM-FS increases to 5.02° in boys, then fluctuates at ∼4.08°, while in girls, it increases to 5.87°, then fluctuates at ∼4.24°. CONCLUSIONS: The pattern found in this study confirms the results of previous publications investigating Caucasian populations; however, absolute values differ significantly in several cases.

Three-dimensional quantitative analysis of the proximal femur and the pelvis in children and adolescents using an upright biplanar slot-scanning X-ray system.

BACKGROUND: The anatomy and biomechanics of the pelvis and lower limbs play a key role in the development of orthopaedic disorders. OBJECTIVE: This study aimed to establish normal reference standards for the measurement of gender-specific pelvic and femoral parameters in children and adolescents with the EOS 2-D/3-D system. MATERIALS AND METHODS: EOS 2-D images of 508 individuals (ages 4-16 years) were obtained as part of routine diagnostics. Patients with lower limb abnormalities were excluded. Pelvic and femoral surface 3-D models were generated and clinical parameters calculated by sterEOS 3-D reconstruction software. Data were evaluated using Spearman correlation, paired-samples and independent-samples t-test and linear regression analysis. RESULTS: Changes in anatomical parameters were found to correlate with age and gender in 1) femoral mechanical axis length: 27.3-43.7 cm (males), 25.5-41.2 cm (females), 2) femoral head diameter: 29.4-46.1 mm (males), 27.7-41.3 mm (females), 3) femoral offset: 26.8-42.4 mm (males), 25.5-37.9 mm (females) and 4) femoral neck length: 35.1-52.9 mm (males), 32.8-48.1 mm (females). There was no gender-specific correlation for the neck shaft angle with values from 130.4° to 129.3°, for femoral torsion (22.5°-19.4°), for sacral slope (39.0°-44.4°) and for lateral pelvic tilt (5.1 mm-6.2 mm). Sagittal pelvic tilt exhibited no significant correlation with age showing average values of 6.5°. CONCLUSIONS: The EOS 2-D/3-D system proved to be a valuable method in the evaluation of female and male developmental changes in pelvic and lower limb anatomical parameters, in normal individuals younger than 16 years of age.

[Evaluation of the usefulness of the EOS 2D/3D system for the measurement of lower limbs anatomical and biomechanical parameters in children]. / Az EOS 2D/3D System alkalmazhatóságának vizsgálata a szabad alsó végtag anatómiai és biomechanikai paramétereinek mérésére gyermekkorban.

INTRODUCTION: Lower limbs anatomical and biomechanical parameters are essential in several paediatric orthopaedic disease, which makes their exact measurement necessary. AIM: The aim of the author was to evaluate the reliability of the EOS 2D/3D System, a 3D reconstruction capable imaging device in children. METHOD: 3D reconstructions were performed in 523 cases aged between 2 and 16 years in whom no abnormality influencing lower limbs biomechanics was observed. For statistical analysis intraclass correlation, paired-samples t-test, Spearman-correlation and Welch-test were used. RESULTS: Excellent results were found for all parameters in reliability test used by the operator. The step-forward position used during the examination influenced the sagittal tibiofemoral angle only. All examined parameters showed significant correlation with age and gender. Height correlated with neck-shaft angle, hip-knee shift, femoral and tibial torsion only. CONCLUSIONS: The EOS technology proved to be an appropriate method to measure lower limbs anatomical parameters in children. Changes in these parameters during development correlated with age and gender.

Geometrical values of the normal and arthritic hip and knee detected with the EOS imaging system.

PURPOSE: EOS 2D/3D is an integrated, low-dose orthopedic digital radioimaging solution, which, due to its groundbreaking properties, has recently shown an increasing application in scoliosis surgery. Its integrated sterEOS 3D software allows creation of patient-specific three-dimensional (3D) lower limb models, and can produce geometrical parameters in 3D. Currently there are a limited number of reports on EOS for lower limb applications. METHODS: Three-dimensional reconstructions of 256 hip and knee joints of 128 healthy subjects, as well as 53 hips and 46 knees of 69 patients with hip or knee arthritis, were evaluated based on orthogonal EOS two-dimensional (2D) images. Measurements for hips included femur and tibia length, total length of the extremity, femoral antetorsion and offset, femoral neck length, neck-shaft and hip-knee-shaft (HKS) angles. Lower limb alignment in both frontal and sagittal planes were determined in normal and arthritic knees. Values were compared with those obtained by standard methods published by others. RESULTS: Normal hip and knee geometrical parameters were found in our healthy subjects. In osteoarthritic cases, values for neck-shaft angle, femoral antetorsion, femur length and total length of the extremity were shown to decrease non-significantly. Evaluation of lower limb alignment in healthy and arthritic knees showed normal values in healthy subjects apart from three cases with an average six degrees varus. Arthritic knees were most frequently found to have a varus angulation, with the exception of 11 cases with normal or valgus alignment. CONCLUSION: EOS 2D/3D with its sterEOS 3D reconstruction is useful for a comprehensive 3D examination of the lower limb. In the near future it may be suitable for daily routine diagnostics of orthopedic lower limb deformities as a primary examination method.