title: Estimation of the recovery of physiological genu varum with linear mixed model.
abstract: BACKGROUND
  Although previous studies have provided reference values for the lower limb alignment in children with physiological genu varum, those often have methodologic flaws, including problems with assumptions of statistical independence. In this study we intend to use appropriate statistical methods to determine reference values of the recovery of physiological genu varum by using a linear mixed model (LMM).
  
  
  METHODS
  The database of our institution was searched and teleroentgenograms of patients up to 5 years of age with clinical diagnosis of physiological genu varum were selected. The mechanical tibiofemoral angle (mTFA), mechanical lateral distal femoral angle (mLDFA), and mechanical medial proximal tibial angle (mMPTA) were measured from each radiograph. These measures were then incorporated in LMM. The reference values for mTFA, mLDFA, and mMPTA were calculated by LMMs with age, sex, and side of the limbs, as the fixed effects with each subject as random effects.
  
  
  RESULTS
  A total of 425 teleroentgenograms were evaluated from 161 patients with physiological genu varum. Age, sex, and limb side terms were found to be significant contributing factors to the measures. In the LMM, with the age as quadratic, mTFA was equal to -0.3-degree varus [95% confidence interval (CI), -5.9 to 5.3 degrees] at the age of 3 years. The mLDFA was equal to 87.8 degrees (95% CI, 82.8-92.8 degrees) at the age of 4.5 years. The mMPTA was equal to 88.8 degrees (95% CI, 80.4-97.2 degrees) at the age of 2.5 years.
  
  
  CONCLUSIONS
  An LMM fitted well to estimate the natural recovery of physiological genu varum. Age, sex, and side of the limbs were found to be significant factors in the estimation of mTFA, and age and side of limbs were significant in estimation of mLDFA and mMPTA.
  
  
  METHODS
  Level III-diagnostic study.
authors: Department of Orthopaedic Surgery , Seoul National University Bundang Hospital, Kyungki, Korea.
authors: Bekhzad
authors: B
authors: Akhmedov
authors: Soyeon
authors: S
authors: Ahn
authors: Chin Youb
authors: CY
authors: Chung
authors: Kyung Min
authors: KM
authors: Lee
authors: Ki Hyuk
authors: KH
authors: Sung
authors: Tae Won
authors: TW
authors: Kim
authors: Seung Yeol
authors: SY
authors: Lee
authors: In Ho
authors: IH
authors: Choi
authors: Tae-Joon
authors: TJ
authors: Cho
authors: Won Joon
authors: WJ
authors: Yoo
authors: Moon Seok
authors: MS
authors: Park
mesh_terms: D000367:Age Factors; D002675:Child, Preschool; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging* / Q000502:physiology; D056305:Genu Varum / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D016014:Linear Models; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D012737:Sex Factors; D013977:Tibia / Q000000981:diagnostic imaging* / Q000502:physiology