Predicting Growth Quantitatively Through Proximal Tibia Radiograph Markers.

BACKGROUND: The creation of accurate markers for skeletal maturity has been of significant interest to orthopaedic surgeons. They guide the management of diverse disorders such as adolescent idiopathic scoliosis, leg length discrepancy, cruciate ligament injuries, and slipped capital femoral epiphysis. Multiple systems have been described to predict growth using radiographic skeletal markers; however, no such system has yet been developed for the proximal tibia. The purpose of this study was to establish quantitative radiographic parameters within the proximal tibia that can be used to assess degree of skeletal maturity. METHODS: From the Bolton Brush collection, 94 children, consisting of 49 girls and 4 boys between the ages of 3 and 18 years old, were followed annually throughout growth with serial radiographs and physical examinations. Final height at maturity was used to calculate the growth remaining at each visit. Multiple measurements for each knee radiograph were performed and correlated with the percentage of growth remaining. Tibial epiphysis width, tibial metaphysis width, and height of the lateral tibial epiphysis were measured on each film and the composite ratios between each of these sets of variables along with their respective accuracy and reliability were calculated. Single and multiple linear regression models were constructed to determine accuracy of prediction. Interobserver and intraobserver studies were performed with 4 investigators ranging from medical student to senior attending and calculated using the intraclass correlation coefficient. All 4 examiners measured all of the subjects and the ratios created were averaged. RESULTS: Tibial epiphysis width, tibial metaphysis width, and height of the lateral tibial epiphysis were all found to be strongly correlated with growth remaining with R values ranging from 0.57 to 0.84. In addition, all 3 ratios were found to be reliable with intraobserver and interobserver intraclass correlation coefficients ranging from 0.92 to 0.94 and 0.80 to 0.94, respectively. A multiple linear regression model demonstrated that combining these 3 ratios allows for a predictive R value of 0.917, showing that these ratios when combined were highly predictive of growth remaining. All findings were independent of sex (P=0.996). CONCLUSIONS: We describe 3 measurements that can easily be obtained on an anteroposterior radiograph of the knee. We demonstrate that ratios of these variables can be measured reliably and correlate closely with remaining growth, independent of sex. Together, we believe that these factors will improve the accuracy of determining growth from lower extremity radiographs that include the proximal tibia. CLINICAL RELEVANCE: This study provides a new quantitative technique to evaluate growth in the lower extremity, which can inform a range of conditions including adolescent idiopathic scoliosis, leg length discrepancy, cruciate ligament injury, and slipped capital femoral epiphyses.

Índice cobertura POS: procedimiento de medición de la relación entre balón y mano / POS. Coverage index: measurement procedure of the relationship between ball and hand

Este trabajo diseña un novedoso procedimiento de medición que relaciona el tamaño de la mano y el tamaño del balón. Se detalla este procedimiento ideado para la determinación del «Índice de Cobertura de la Mano Porras, Oliver, Sosa» (I.C.M.P.O.S.) sobre el balón. A partir de tres medidas obtenidas de la mano dominante de los deportistas con la mano en máxima apertura tomadas sobre un plano, calcularemos sus coordenadas en el espacio, y las aplicaremos sobre la esfera del balón. Posteriormente, a través de una fórmula, y teniendo en cuenta el valor central de la medida de la circunferencia del balón del deporte y de la categoría deportiva correspondiente, podremos conocer el Índice de Cobertura de la mano del deportista sobre el balón, o cantidad del balón que un deportista es capaz de abarcar con su mano completamente abierta respecto a la media esfera del balón de su categoría deportiva (AU)

This paper designs a novel measurement procedure that relates the size of the hand and the size of the ball. This procedure was devised in order to determine the «Hand Coverage Index of Porras, Oliver, Sosa» (H.C.I.P.O.S.) on the ball. Using three measurements obtained from the dominant hand of athletes with the hand on its maximum aperture taken on a flat plane, we calculated their coordinates in space, and their applications on the sphere of the ball. Subsequently, through a formula, and taking into account the central value of the measurement of the circumference of the ball and the corresponding sport category, we will be able to know the Hand Coverage Index of the athlete over the ball, or the surface of the ball that an athlete is able to cover with his fully open hand with respect to the the sphere of the ball of his sport category (AU)

Trunk deformity evaluation based on 3D measurements of front body surface landmarks in people with severe physical disabilities.

PURPOSE: To assess reliability and validity of a trunk deformity evaluation method expressed as rotational and lateral lean angles between the upper and the lower trunk and between the lower trunk and the pelvis using 3D positions of six front body surface landmarks. METHODS: Inter- and intra-rater reliabilities of the proposed method in adults with typical development (n = 22) were assessed, and its validity was also assessed through correlations between the Cobb angle and the analyzed trunk deformity parameters in adults with severe physical disabilities (n = 22). RESULTS: The mean differences between two raters and between the initial and second measures were within 2°. Moderate correlations were found between the Cobb angle and both the upper and the lower trunk lateral lean angle and the upper trunk rotation angle. CONCLUSIONS: The proposed trunk deformity evaluation appears to be a reliable and valid approach for bedridden people with physical disabilities.

The effects of a reformer Pilates program on body composition and morphological characteristics in active women after a detraining period.

The aim of this quasi-experimental pilot study was to explore the effects of a reformer Pilates program on the anthropometry, body composition, and somatotype of active adult women after a short non-exercise period. Twenty-eight women (mean age: 40.21 ± standard deviation of 8.12 years old) with one to three years of reformer Pilates experience participated in the study. The women participated in a reformer Pilates program for 16 weeks (one hour, twice per week) after 4 weeks of detraining (summer holidays) in 2012. The International Society for the Advancement of Kinanthropometry full profile was assessed before and after the intervention program. Significant decreases (p ≤ 0.05) from pre- to post-program were observed for triceps, iliac crest, supraspinale, abdominal, front thigh and medial calf skinfold thicknesses, six and eight skinfold thickness sums, forearm and ankle girths, waist/hip ratio, endomorphy, and fat mass. Significant increases (p ≤ .05) were observed for corrected arm, corrected calf girths, and muscle mass. Generally, women showed a mesomorphic endomorph (endomorphy predominant) and mesomorph-endomorph (endomorphy and mesomorphy predominant) in the pre- and posttests, respectively. In conclusion, the practice of reformer Pilates was associated with healthy changes in anthropometric parameters, body composition, and somatotype in Pilates-experienced women after 4 weeks of no physical exercise.

Intercondylar Roof Inclination Angle: Is It a Risk Factor for ACL Tears or Tibial Spine Fractures?

BACKGROUND: The relationship between the angle of inclination of the intercondylar roof [roof inclination angle (RIA)] and likelihood of knee injury has not been previously investigated in children. METHODS: Twenty-five skeletally immature patients with a tibial spine fracture were age matched (±1 y) and sex matched with 25 patients with an anterior cruciate ligament (ACL) tear and with 50 control knees (2 for each patient). Demographic and diagnostic information was collected, and radiographic measurements were performed on notch and lateral radiographs of the knee. RESULTS: Patients with a tibial spine fracture had an increased RIA compared with controls and patients with an ACL tear. Patients with ACL tears had a steeper notch roof, as indicated by a decreased RIA when compared with controls and patients with tibial spine fractures. CONCLUSIONS: Our results demonstrated that a decreased RIA was associated with ACL tear and that an increased RIA was associated with tibial spine fracture. LEVEL OF EVIDENCE: Level III-prognostic.

Functional Assessment in Tibial Hemimelia (Can We Also Save the Foot in Reconstruction?).

BACKGROUND: The congenital absence of the tibia is a rare disease, and an orthopaedic surgeon may not encounter such cases during the course of his/her career. This is the largest report to date of the management of such cases by a single surgeon. The foot and leg were persevered in the majority of the cases, and a functional evaluation system was used to report outcomes. METHODS: Thirty-six patients with tibial hemimelia, who had been under the direct care of the authors since infancy, were evaluated clinically and radiographically. The patients or their parents filled out the Pediatric Quality of Life and the parents' satisfaction forms. The surgical interventions performed, and their effects on school attendance and, and also the shoe type they wore were documented. RESULTS: Thirty-six patients (19 girls and 17 boys) with 48 tibial-deficient limbs (19 right, 5 left, and 12 both right and left sides) were studied. The patients were assessed at 12 years (2.5 to 32.5 y), with a mean follow-up of 9 years (2 to 23 y). The 48 limbs included 14 type I, 16 type II, 11 type IV, and 7 unclassified by using the Jones classification; and 6 type I, 11 type II, 16 type III, 1 type IV, and 14 type VII by using the Weber classification. Primary amputation was performed in 8 patients (10 limbs) and limb preservation surgeries on 38 legs (28 patients). Tibiofibular synostosis, centralization of the ankle, and Ilizarov lengthening were the most common procedures. Nonunion of tibiofibular synostosis (2 cases) and knee stiffness (6 cases) were the main complications. Among the reconstructed limbs, 12 were in regular and 18 in modified shoes. The Pediatric Quality of Life of 68 points in the reconstructed group was a significant achievement, and it was also better than the score of patients who had undergone amputation. CONCLUSION: Reconstruction of tibial hemimelia with foot preservation provides good functional outcome in the majority of cases. LEVEL OF EVIDENCE: Level IV.

Intercondylar Notch Width as a Risk Factor for Medial Femoral Condyle Osteochondritis Dissecans in Skeletally Immature Patients.

BACKGROUND: Juvenile osteochondritis dissecans (OCD) of the medial femoral condyle (MFC) is one of the most common causes of knee pain in adolescents. Wilson sign reproduces knee pain with internal rotation of the tibia during extension of the knee from 90 to 30 degrees due to impingement of the tibial eminence on the MFC. This impingement may result in microtrauma and contribute to lesion formation. The purpose of this study was to evaluate anatomic factors that may increase the likelihood of impingement by using magnetic resonance imaging scans of patients with MFC OCD lesions to measure tibial eminence height and femoral notch width. METHODS: A retrospective, case-control study was performed using the radiology database at our institution between July 2009 and February 2014. Magnetic resonance imagings of patients with MFC OCD lesions and matched controls were identified. For each patient, tibial eminence height and femoral notch width were measured and then normalized for patient size [creating the tibial eminence height normalized, and the notch width index (NWI), respectively]. Values for OCD and control knees were compared using Student t test. Interrater and intrarater reliability were calculated using intraclass correlation coefficients. RESULTS: Thirty-five MFC OCD patients and matched controls were identified. Comparison of the groups showed a significantly smaller NWI in MFC OCD knees than in the matched controls (0.2620±0.0248 vs. 0.2886 ±0.0323, P=0.0003). There was no difference in tibial eminence height normalized between groups (0.1387±0.0161 vs. 0.1428±0.0108, P=0.21). Interrater and intrarater reliability of all measurements was good to excellent (0.81 to 1.00) when measurements were made using bony margins. CONCLUSIONS: Knees with MFC OCD lesions have significantly smaller NWIs than matched controls. This anatomic factor may increase the likelihood of tibial eminence impingement and contribute to OCD lesion formation. LEVEL OF EVIDENCE: Level III-case-control study.