title: Tibial length growth curves for ambulatory children and adolescents with cerebral palsy.
abstract: OBJECTIVE
  The aim of this study was to generate growth curves for ambulatory children and adolescents with cerebral palsy (CP) using tibial lengths and to determine if they differed according to sex or Gross Motor Function Classification System (GMFCS) level.
  
  
  METHODS
  Growth data were studied from a cohort of 750 participants (442 males, 308 females [1199 visits]; mean age 10 y 9 mo, SD 3 y 4 mo, range 4-21 y) with CP (hemiplegia, n=163; diplegia, n=573; triplegia, n=11; quadriplegia n=2; GMFCS levels I-III), and 165 typically developing children (96 males, 115 females; [211 visits]) mean age 10 y 9 mo, SD 4 y 2 mo, range 4-19 y). Tibial length measurements calculated from data collected during routine gait analyses were validated using anthropometric tibial length measurements and were used to generate growth curves for males and females classified as GMFCS level I, II, or III. Growth was compared in participants of different sexes and GMFCS levels using the median curves.
  
  
  RESULTS
  Growth curves for males and females (GMFCS levels I-III) with estimate lines for 3rd, 10th, 25th, 50th, 75th, 90th, and 97th centiles were generated. Mean tibial length was greater in males than in females in all GMFCS levels. Tibial lengths were shorter in participants classified as GMFCS level III than in those classified as GMFCS level I or II.
  
  
  CONCLUSIONS
  To our knowledge this is the first large-scale investigation of bone growth in ambulatory children and adolescents with CP. The large sample made it possible to generate growth curves and to provide insight into growth trends. The study findings serve as a basis for analysis of the relationships between growth, function, and treatment outcomes.
authors.affiliation: Medical Staff Research, Shriners Hospitals for Children, Lexington, KY 40502, USA. doeffinger@shrinenet.org
authors.forename: Donna
authors.initials: D
authors.lastname: Oeffinger
authors.forename: Mark
authors.initials: M
authors.lastname: Conaway
authors.forename: Richard
authors.initials: R
authors.lastname: Stevenson
authors.forename: John
authors.initials: J
authors.lastname: Hall
authors.forename: Robert
authors.initials: R
authors.lastname: Shapiro
authors.forename: Chester
authors.initials: C
authors.lastname: Tylkowski
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D016022:Case-Control Studies; D002547:Cerebral Palsy / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D057238:Growth Charts; D006801:Humans; D008297:Male; D015588:Observer Variation; D010291:Paresis / Q000473:pathology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D013977:Tibia / Q000254:growth & development* / Q000473:pathology*; D016138:Walking; D055815:Young Adult