title: The normal radiological anteroposterior alignment of the lower limb in children.
abstract: BACKGROUND
  The development of reconstructive surgery of the lower limbs aimed at multilevel correction demands a precise knowledge of the physiological variations in general radiological parameters of the lower limbs in children of various age groups. It is crucial in systemic skeletal diseases, when deformities affect limbs and the surgeon does not have an intact limb as a reference. The aim of this retrospective study was to establish the normal radiological values of lower limb parameters used in the surgical correction of deformities in children of various age groups.
  
  
  METHODS
  Teleradiographs of the lower limbs taken in children with unilateral congenital or posttraumatic deformity were retrospectively reviewed. Weight-bearing full-length anteroposterior radiographs of the entire lower extremities were taken in a standing position. The study involved 215 extremities of 208 children (93 girls and 115 boys); the ages ranged from 2 years 1 month to 15 years 11 months old. Key variables included the anatomic medial proximal femoral angle (aMPFA), anatomic lateral distal femoral angle (aLDFA), anatomic medial proximal tibial angle (aMPTA), anatomic lateral distal tibial angle (aLDTA), mechanical axis deviation (MAD), the angle formed by the femoral anatomical axis and the mechanical axis of the lower limb.
  
  
  RESULTS
  The means and dynamics of variations, standard deviations (SD) and 95% confidence intervals of each parameter were calculated for each age and gender group. Simple regression analysis was performed to determine the relationship between the patient's age and the magnitude of aMPFA, aLDFA, aMPTA and aLDTA. Simple regression analysis showed a significant inverse correlation between patient age and the magnitude of aMPFA: the correlation coefficient was -0.77. A statistically significant inverse correlation between the MAD and the angle between the anatomic femoral axis and mechanical limb axis was found: the correlation coefficient was -0.53.
  
  
  CONCLUSIONS
  In general, the received values were concordant to results of other studies. It concerned the MAD, aLDFA, aMPTA and angle between the mechanical limb axis and anatomic femoral axis. This is the first chronological evaluation of aMPFA and aLDTA from a relavively large series of patients. These normative data should be taken into consideration when evaluating lower limb alignment in children or applied in practice for planning and evaluation of the quality of surgical correction of complex deformities.
authors.affiliation: Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, 6, M. Ulyanova Street, 640014, Kurgan, Russian Federation, dpopkov@mail.ru.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Popkov
authors.forename: Pierre
authors.initials: P
authors.lastname: Lascombes
authors.forename: Nicolas
authors.initials: N
authors.lastname: Berte
authors.forename: Laurent
authors.initials: L
authors.lastname: Hetzel
authors.forename: Bruno Ribeiro
authors.initials: BR
authors.lastname: Baptista
authors.forename: Arnold
authors.initials: A
authors.lastname: Popkov
authors.forename: Pierre
authors.initials: P
authors.lastname: Journeau
mesh_terms: D000293:Adolescent; D000375:Aging / Q000502:physiology*; D059925:Anatomic Landmarks / Q000000981:diagnostic imaging / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000254:growth & development; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging* / Q000254:growth & development*; D008297:Male; D011859:Radiography; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012727:Sex Characteristics; D013977:Tibia / Q000000981:diagnostic imaging / Q000254:growth & development