The Modified Fels and Abbreviated Modified Fels Knee Skeletal-Maturity Systems in the Prediction of Leg-Length Discrepancy

被引:2
|
作者
Kluck, Dylan G. [1 ]
Makarov, Marina R. [2 ]
Podeszwa, David A. [2 ]
Furdock, Ryan J. [3 ]
Liu, Raymond W. [4 ]
Jo, Chan-Hee [2 ]
Birch, John G. [2 ]
机构
[1] Univ Kentucky, Dept Orthopaed Surg & Sports Med, Shriners Childrens Lexington, Lexington, KY 40506 USA
[2] Texas Scottish Rite Hosp Children, Dallas, TX USA
[3] Univ Hosp Cleveland Med Ctr, Dept Orthoped, Cleveland, OH USA
[4] Rainbow Babies & Childrens Hosp, Cleveland, OH USA
来源
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME | 2024年 / 106卷 / 02期
关键词
SECONDARY SEXUAL CHARACTERISTICS; PEDIATRIC RESEARCH; EPIPHYSIODESIS; GREULICH; TANNER; GROWTH; ARREST; GIRLS; PYLE;
D O I
10.2106/JBJS.23.00286
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: The Modified Fels (mFels) and Abbreviated Modified Fels (abFels) knee systems have been recently developed as options for grading skeletal maturity without the need for a separate hand radiograph. We sought to determine the interobserver reliability of these systems and to compare their prediction accuracy with that of the Greulich and Pyle (G-P) atlas in a cohort managed with epiphysiodesis for leg-length discrepancy (LLD).Methods: Three reviewers scored 20 knee radiographs using the mFels system, which includes 5 qualitative and 2 quantitative measures as well as a quantitative output. Short leg length (SL), long leg length (LL), and LLD prediction errors at maturity using the White-Menelaus (W-M) method and G-P, mFels, or abFels skeletal age were compared in a cohort of 60 patients managed with epiphysiodesis for LLD.Results: Intraclass correlation coefficients for the 2 quantitative variables and the quantitative output of the mFels system using 20 knee radiographs ranged from 0.55 to 0.98, and kappa coefficients for the 5 qualitative variables ranged from 0.56 to 1, indicating a reliability range from moderate to excellent. In the epiphysiodesis cohort, G-P skeletal age was on average 0.25 year older than mFels and abFels skeletal ages, most notably in females. The majority of average prediction errors between G-P, mFels, and abFels were <0.5 cm, with the greatest error being for the SL prediction in females, which approached 1 cm. Skeletal-age estimates with the mFels and abFels systems were statistically comparable.Conclusions: The mFels skeletal-age system is a reproducible method of determining skeletal age. Prediction errors in mFels and abFels skeletal ages were clinically comparable with those in G-P skeletal ages in this epiphysiodesis cohort. Further work is warranted to optimize and validate the accuracy of mFels and abFels skeletal ages to predict LLD and the impact of epiphysiodesis, particularly in females. Both the mFels and abFels systems are promising means of estimating skeletal age, avoiding additional radiation and health-care expenditure.Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
引用
收藏
页码:145 / 150
页数:6
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