Evaluation of age group and sex differences in the measurement of patellar height of pediatric knee in a Korean population

Yoon Hae Kwak; Soo-Sung Park; Aaron J Huser; Hyo Won Lim; Sharkawy Wagih Abdel Baki; Yong-Gon Koh; Ji-Hoon Nam; Kyoung-Tak Kang

doi:10.3389/fped.2022.1021147

Evaluation of age group and sex differences in the measurement of patellar height of pediatric knee in a Korean population

Front Pediatr. 2023 Jan 16:10:1021147. doi: 10.3389/fped.2022.1021147. eCollection 2022.

Authors

Yoon Hae Kwak¹, Soo-Sung Park¹, Aaron J Huser², Hyo Won Lim¹, Sharkawy Wagih Abdel Baki^{3

4}, Yong-Gon Koh⁵, Ji-Hoon Nam⁶, Kyoung-Tak Kang⁶

Affiliations

¹ Department of Orthopedic Surgery, Asan Medical Center, Seoul, South Korea.
² Paley Advanced Limb Lengthening Institute, St. Mary's Hospital, West Palm Beach, FL, United States.
³ Department of Orthopedic Surgery, Aswan University Hospital, Aswan, Egypt.
⁴ Department of Orthopaedis Surgery, Severance Children's Hospital, Seoul, South Korea.
⁵ Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, South Korea.
⁶ Department of Mechanical Engineering, Yonsei University, Seoul, South Korea.

Abstract

Introduction: Various methods based on bony landmarks are used to determine patellar height. This study analyzed five methods for patellar height measurement on lateral knee radiographs, namely, the Insall-Salvati, Koshino-Sugimoto, Blackburne-Peel, modified Insall-Salvati, and Caton-Deschamps methods.

Methods: Overall, 425 pediatric participants (221 males, 204 females; age range 5-18 years) were included and were divided equally into three age groups (A, 5-10 years; B, 11-13 years; and C, 13-18 years). For the comparison of the applicability of each method, the applicable probabilities for each age group and sex-based differences were analyzed using logistic regression techniques. Intra-rater reliability and inter-rater variability were analyzed by two trained raters.

Results: The Koshino-Sugimoto method was applicable to all patients. The 80% applicable age of female patients was lower than that of male patients for the Blackburne-Peel (male = 11.9, female = 11) and Caton-Deschamps (male = 11.9, female = 11.1) methods. However, in the Insall-Salvati (male = 12, female = 12.1) and modified Insall-Salvati (male = 12.6, female = 13.1) methods, the 80% applicable age in male patients was lower than that in female patients. The Koshino-Sugimoto method showed the highest variability in group B, while the Insall-Salvati showed the highest variability in group C. In terms of intra-observer reliability, the Caton-Deschamps method showed the same reliability as the Insall-Salvati method, in group C.

Conclusions: Our results demonstrated differences in the reliability, variability, and applicability of patellar height measurement methods according to age group. The applicability of patellar height measurement methods also differed according to sex. Therefore, based on age group and sex, different methods should be used for patellar height measurement in pediatric patients.

Keywords: Korean pediatric patients; insall-Salvati index; patella height; radiograph; reliability.