Absence de corrélation entre inégalité de longueur modérée des membres inférieurs et maladie dégénérative du rachis, de la hanche, du genou : étude cadavérique - 06/07/18

No relationship between mild limb length discrepancy and spine, hip or knee degenerative disease in a large cadaveric collection

Doi : 10.1016/j.rcot.2018.04.019

Raymond W. Liu ^a,^⁎ , Jonathan J. Streit ^b, Douglas S. Weinberg ^c, Jeremy D. Shaw ^d, Elyse LeeVan ^e, Daniel R. Cooperman ^f
^a Division of Pediatric Orthopaedic Surgery, Case Western Reserve University at Rainbow Babies and Children's Hospital, 11100, Euclid Avenue, RBC 6081, OH 44106 Cleveland, États-Unis
^b Department of Orthopaedic Surgery, Cleveland Clinic Akron General, Akron, Ohio, États-Unis
^c Division of Pediatric Orthopaedic Surgery, Case Western Reserve University at Rainbow Babies and Children's Hospital, Cleveland, Ohio, États-Unis
^d Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, États-Unis
^e Department of General Surgery, Huntington Hospital, Pasadena, California, États-Unis
^f Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, États-Unis

^⁎Auteur correspondant.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 06 July 2018
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Abstract

Background

Although asymptomatic mild limb length discrepancy (LLD) in children is generally treated non-operatively, there is limited high quality follow up data to support this recommendation.

Hypothesis

We hypothesized that there would be no association between LLD and arthritic changes with mild limb length discrepancy.

Materials and methods

We studied 576 well-preserved cadaveric skeletons ranging from 40 to 79 years of age. Limb length discrepancy was based on combined femoral and tibial lengths measured using digital calipers. Degenerative disease was hand graded in the spine, hips and knees using a previously described classification system. Power was set at 90%.

Results

Average age was 56±10 years, and average LLD was 4.8±4.0mm. Multiple regression analysis did not demonstrate any correlation between LLD and degenerative disease. After screening to find 26 additional specimens with LLD 10mm or greater, and assessing a potentially quadratic relationship, we still did not find any detrimental effects of LLD.

Discussion

Our data support the general clinical recommendation of observation for mild asymptomatic LLD. These results do not apply to larger LLD nor LLD associated with other deformities or clinical symptoms.

Level of evidence

Not applicable, anatomic basic science study.

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Keywords : Limb length discrepancy, Limb deformity, Degenerative joint disease, Osteoarthritis, Epiphyseodesis

☆	Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology: Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus.