TY - JOUR
T1 - Capital femoral growth plate extension predicts cam morphology in a longitudinal radiographic study
AU - Morris, William Z.
AU - Weinberg, Douglas S.
AU - Gebhart, Jeremy J.
AU - Cooperman, Daniel R.
AU - Liu, Raymond W.
N1 - Publisher Copyright:
© 2016 By the Journal of Bone and Joint Surgery, Incorporated.
PY - 2016/5/18
Y1 - 2016/5/18
N2 - Background: Recent evidence has suggested that cam morphology may be related to alterations in the capital femoral growth plate during adolescence. The purpose of this study was to evaluate the relationship between capital femoral growth plate extension and cam morphology in a longitudinal radiographic study. Methods: We used a historical, longitudinal radiographic collection to identify 96 healthy adolescents (54 boys and 42 girls) with at least 5 consecutive annual radiographs of the left hip including closure of the capital femoral physis. We reviewed 554 anteroposterior radiographs of the left hip to measure the anteroposterior modification of the alpha angle of Nötzli and of the superior epiphyseal extension ratio (EER), measured as the ratio of extension of the capital femoral epiphysis down the femoral neck relative to the diameter of the femoral head. Measurements were made at 3 points in femoral head maturation corresponding to the Oxford bone age (OBA) femoral head stages 5, 6, and 7/8. Results: There was a mean increase in the anteroposterior alpha angle (10.7° ± 14.0°) and EER (0.12 ± 0.08) between OBA stages 5 and 7/8, corresponding to maturation and closure of the capital femoral physis. There was a positive correlation between the final anteroposterior alpha angle and both the final EER (r = 0.60) and the change in the EER (r = 0.58). A receiver operating characteristic curve generated to predict an anteroposterior alpha angle of ≥78° through the EER demonstrated an area under the curve of 0.93, indicating that an increasing EER had excellent diagnostic accuracy for predicting concurrent cam morphology. Conclusions and Clinical Relevance: Superior epiphyseal extension was directly and temporally associated with an increase in anteroposterior alpha angle and more cam-like morphology. This alteration in the capital femoral epiphysis occurred immediately before physeal closure (OBA stage 7/8). Given the association of epiphyseal extension with activities that increase shear forces across the physis, we proposed that epiphyseal extensionmay be an adaptivemechanism to stabilize the physis and prevent slipped capital femoral epiphysis.
AB - Background: Recent evidence has suggested that cam morphology may be related to alterations in the capital femoral growth plate during adolescence. The purpose of this study was to evaluate the relationship between capital femoral growth plate extension and cam morphology in a longitudinal radiographic study. Methods: We used a historical, longitudinal radiographic collection to identify 96 healthy adolescents (54 boys and 42 girls) with at least 5 consecutive annual radiographs of the left hip including closure of the capital femoral physis. We reviewed 554 anteroposterior radiographs of the left hip to measure the anteroposterior modification of the alpha angle of Nötzli and of the superior epiphyseal extension ratio (EER), measured as the ratio of extension of the capital femoral epiphysis down the femoral neck relative to the diameter of the femoral head. Measurements were made at 3 points in femoral head maturation corresponding to the Oxford bone age (OBA) femoral head stages 5, 6, and 7/8. Results: There was a mean increase in the anteroposterior alpha angle (10.7° ± 14.0°) and EER (0.12 ± 0.08) between OBA stages 5 and 7/8, corresponding to maturation and closure of the capital femoral physis. There was a positive correlation between the final anteroposterior alpha angle and both the final EER (r = 0.60) and the change in the EER (r = 0.58). A receiver operating characteristic curve generated to predict an anteroposterior alpha angle of ≥78° through the EER demonstrated an area under the curve of 0.93, indicating that an increasing EER had excellent diagnostic accuracy for predicting concurrent cam morphology. Conclusions and Clinical Relevance: Superior epiphyseal extension was directly and temporally associated with an increase in anteroposterior alpha angle and more cam-like morphology. This alteration in the capital femoral epiphysis occurred immediately before physeal closure (OBA stage 7/8). Given the association of epiphyseal extension with activities that increase shear forces across the physis, we proposed that epiphyseal extensionmay be an adaptivemechanism to stabilize the physis and prevent slipped capital femoral epiphysis.
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U2 - 10.2106/JBJS.15.01028
DO - 10.2106/JBJS.15.01028
M3 - Article
C2 - 27194490
AN - SCOPUS:84978817819
SN - 0021-9355
VL - 98
SP - 805
EP - 812
JO - Journal of Bone and Joint Surgery - American Volume
JF - Journal of Bone and Joint Surgery - American Volume
IS - 10
ER -