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Breech presentation is a risk factor for dysplasia of the femoral trochlea.

Øye CR, Foss OA, Holen KJ - Acta Orthop (2015)

Bottom Line: The way of fetal presentation at birth and standard parameters such as sex, gestational age, and length and weight at birth were registered.The incidence of breech position in these children was 15-fold higher.For some newborns, a high sulcus angle can be found at birth, indicating that trochlear dysplasia can be found from birth.

View Article: PubMed Central - PubMed

Affiliation: a Department of Orthopaedic Surgery , Trondheim University Hospital , Trondheim , Norway.

ABSTRACT

Background and purpose: Instability of the patellofemoral joint is a common disorder in children and young adults. Although it has multifactorial causes, a shallow femoral trochlea is the single most important factor for instability. There is no consensus as to the etiology of trochlear dysplasia. We assessed whether the presentation of the fetus at birth could be a predisposing factor for trochlear dysplasia.

Subjects and methods: We examined 348 knees in 174 newborns using ultrasonography, concentrating especially on the trochlea femoris. We measured the sulcus angle (SA) on a transverse scan. The way of fetal presentation at birth and standard parameters such as sex, gestational age, and length and weight at birth were registered. As breech presentation is a known risk factor for dysplasia of the hip, we also looked for an association between dysplasia of the femoral trochlea and dysplasia of the hips.

Results: The mean SA was 148°. 17 knees in 14 children had an SA of >159°, which was defined as the threshold value for dysplasia. The incidence of breech position in these children was 15-fold higher. Of the different groups of breech positions, a child in frank breech with the knees locked in extension had a 45-fold increased risk of having trochlear dysplasia.

Interpretation: For some newborns, a high sulcus angle can be found at birth, indicating that trochlear dysplasia can be found from birth. Breech presentation with knees extended appears to be a major risk factor for development of trochlear dysplasia.

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Related in: MedlinePlus

Flow chart illustrating the statistical analyses. These were performed in 3 main steps. In the first step, all 174 children were included, The sulcus angle (SA) was analyzed as a continuous variable. In the second step, 4 children with unknown birth presentation were excluded from further analysis. The SA was analyzed as a dichotomous variable when describing the odds ratio for dysplasia with respect to birth presentation. In the final step, knees of unknown position were excluded to obtain the odds ratio for dysplasia with respect to knee position.
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Figure 0003: Flow chart illustrating the statistical analyses. These were performed in 3 main steps. In the first step, all 174 children were included, The sulcus angle (SA) was analyzed as a continuous variable. In the second step, 4 children with unknown birth presentation were excluded from further analysis. The SA was analyzed as a dichotomous variable when describing the odds ratio for dysplasia with respect to birth presentation. In the final step, knees of unknown position were excluded to obtain the odds ratio for dysplasia with respect to knee position.

Mentions: All statistical calculations were performed using IBM SPSS Statistics version 21. Visual inspection of Q-Q plots was used to determine whether data were normally distributed. The sulcus angle measurements were normally distributed. The statistical analyses were performed in 3 steps (Figure 3). First, all 174 children were included when presenting the descriptive statistics. A paired-samples Student t-test was used when comparing sulcus angle measurements from left and right knees and an independent Student t-test was used when comparing sulcus angle measurements between sexes. Secondly, as birth presentation was believed to be a significant variable, children with unknown presentation were removed from the analysis and the remainder (n = 170) were included in the regression analysis that followed. Finally, knees of unknown position were removed and the remainder (n = 330) were included when describing the odds ratio for dysplasia with respect to knee position.Figure 3.


Breech presentation is a risk factor for dysplasia of the femoral trochlea.

Øye CR, Foss OA, Holen KJ - Acta Orthop (2015)

Flow chart illustrating the statistical analyses. These were performed in 3 main steps. In the first step, all 174 children were included, The sulcus angle (SA) was analyzed as a continuous variable. In the second step, 4 children with unknown birth presentation were excluded from further analysis. The SA was analyzed as a dichotomous variable when describing the odds ratio for dysplasia with respect to birth presentation. In the final step, knees of unknown position were excluded to obtain the odds ratio for dysplasia with respect to knee position.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940585&req=5

Figure 0003: Flow chart illustrating the statistical analyses. These were performed in 3 main steps. In the first step, all 174 children were included, The sulcus angle (SA) was analyzed as a continuous variable. In the second step, 4 children with unknown birth presentation were excluded from further analysis. The SA was analyzed as a dichotomous variable when describing the odds ratio for dysplasia with respect to birth presentation. In the final step, knees of unknown position were excluded to obtain the odds ratio for dysplasia with respect to knee position.
Mentions: All statistical calculations were performed using IBM SPSS Statistics version 21. Visual inspection of Q-Q plots was used to determine whether data were normally distributed. The sulcus angle measurements were normally distributed. The statistical analyses were performed in 3 steps (Figure 3). First, all 174 children were included when presenting the descriptive statistics. A paired-samples Student t-test was used when comparing sulcus angle measurements from left and right knees and an independent Student t-test was used when comparing sulcus angle measurements between sexes. Secondly, as birth presentation was believed to be a significant variable, children with unknown presentation were removed from the analysis and the remainder (n = 170) were included in the regression analysis that followed. Finally, knees of unknown position were removed and the remainder (n = 330) were included when describing the odds ratio for dysplasia with respect to knee position.Figure 3.

Bottom Line: The way of fetal presentation at birth and standard parameters such as sex, gestational age, and length and weight at birth were registered.The incidence of breech position in these children was 15-fold higher.For some newborns, a high sulcus angle can be found at birth, indicating that trochlear dysplasia can be found from birth.

View Article: PubMed Central - PubMed

Affiliation: a Department of Orthopaedic Surgery , Trondheim University Hospital , Trondheim , Norway.

ABSTRACT

Background and purpose: Instability of the patellofemoral joint is a common disorder in children and young adults. Although it has multifactorial causes, a shallow femoral trochlea is the single most important factor for instability. There is no consensus as to the etiology of trochlear dysplasia. We assessed whether the presentation of the fetus at birth could be a predisposing factor for trochlear dysplasia.

Subjects and methods: We examined 348 knees in 174 newborns using ultrasonography, concentrating especially on the trochlea femoris. We measured the sulcus angle (SA) on a transverse scan. The way of fetal presentation at birth and standard parameters such as sex, gestational age, and length and weight at birth were registered. As breech presentation is a known risk factor for dysplasia of the hip, we also looked for an association between dysplasia of the femoral trochlea and dysplasia of the hips.

Results: The mean SA was 148°. 17 knees in 14 children had an SA of >159°, which was defined as the threshold value for dysplasia. The incidence of breech position in these children was 15-fold higher. Of the different groups of breech positions, a child in frank breech with the knees locked in extension had a 45-fold increased risk of having trochlear dysplasia.

Interpretation: For some newborns, a high sulcus angle can be found at birth, indicating that trochlear dysplasia can be found from birth. Breech presentation with knees extended appears to be a major risk factor for development of trochlear dysplasia.

Show MeSH
Related in: MedlinePlus