Detecting Anatomical Leg Length Discrepancy Using the Plug-in-Gait Model (original) (raw)
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BMJ case reports, 2017
Leg length discrepancy (LLD) is associated with many musculoskeletal disorders. Its clinical significance is unclear mainly due to limited functional measurement capacity. An integrated approach measuring true LLD, gait deviations and functional leg length during the gait cycle, based on location of joint centre and anatomical landmarks using a three-dimensional motion analysis system was performed on two patients. In one case, strong agreement was found between all measurements thus, leading to the same treatment intervention. However, in another case, true LLD was not correlated with functional LLD or gait deviations, which led to contradictory results. Functional LLD was found to be correlated with gait deviations in both cases. Our results indicate the effectiveness of integrating into the diagnostic regimen, a dynamic method of measuring LLD, together with the functional outcome of gait deviations as a basis for decision-making regarding the presence and clinical significance o...
British Medical Journal, Case Reports, 2017
Leg length discrepancy (LLD) is associated with many musculoskeletal disorders. Its clinical significance is unclear mainly due to limited functional measurement capacity. An integrated approach measuring true LLD, gait deviations and functional leg length during the gait cycle, based on location of joint centre and anatomical landmarks using a three-dimensional motion analysis system was performed on two patients. In one case, strong agreement was found between all measurements thus, leading to the same treatment intervention. However, in another case, true LLD was not correlated with functional LLD or gait deviations, which led to contradictory results. Functional LLD was found to be correlated with gait deviations in both cases. Our results indicate the effectiveness of integrating into the diagnostic regimen, a dynamic method of measuring LLD, together with the functional outcome of gait deviations as a basis for decision-making regarding the presence and clinical significance of LLD in musculoskeletal disorders.
Methods for Assessing Leg Length Discrepancy
Clinical Orthopaedics and Related Research, 2008
The use of accurate and reliable clinical and imaging modalities for quantifying leg-length discrepancy (LLD) is vital for planning appropriate treatment. While there are several methods for assessing LLD, we questioned how these compared. We therefore evaluated the reliability and accuracy of the different methods and explored the advantages and limitations of each method. Based on a systematic literature search, we identified 42 articles dealing with various assessment tools for measuring LLD. Clinical methods such as use of a tape measure and standing blocks were noted as useful screening tools, but not as accurate as imaging modalities. While several studies noted that the scanogram provided reliable measurements with minimal magnification, a full-length standing AP computed radiograph (teleoroentgenogram) is a more comprehensive assessment technique, with similar costs at less radiation exposure. We recommend use of a CT scanogram, especially the lateral scout view in patients with flexion deformities at the knee. Newer modalities such as MRI are promising but need further investigation before being routinely employed for assessment of LLD. Level of Evidence: Level IV, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Singapore medical journal, 2011
The aim of this study was to determine the reliability and accuracy of the tape measurement method (TMM) with a nearest reading of 5 mm in assessing leg length discrepancy (LLD). This was a cross-sectional study conducted on 35 patients with LLD and 13 patients without LLD. Two blinded surgeons measured the lower limbs from the anterior superior iliac spine to the medial malleolus using TMM with a nearest reading of 5 mm. Computed tomography (CT) scanograms of the lower limbs of 22 patients were conducted by two blinded radiologists. Intraclass correlation coefficient (ICC) with 95 percent confidence interval was calculated to assess the interobserver reliability of TMM. The accuracy of TMM was assessed by comparison with CT as the gold standard. The interobserver reliability of LLD measurement using both TMM and CT scanogram was high, with ICCs of 0.924 and 0.971, respectively. No significant mean difference on paired sample t-test was observed for both TMM and CT scanogram. Compar...
Leg length discrepancy: a brief review
2018
Leg length discrepancy (LLD) is a common orthopedic condition, characterized by a length difference between the two lower limbs, usually associated with alignment disorders. Minor LLD is recognized as a normal variation and has no significant clinical manifestations. However, a discrepancy greater than 1 cm can potentially cause altered biomechanics. These changes can lead to functional limitations and musculoskeletal disorders. This review aims to, not only do a brief consolidation of the current information about the classification, etiology and complications of LLD and angular deformity, but also summarize the various clinical and imaging methods for assessing discrepancy and present the available treatment options, which have been suffering some changes in the last years. Therefore, this essay gathers papers published up to March 2018 obtained through PubMed database using the following search terms: “leg length discrepancy” and “leg lengthening”. Effectively, more accurate meth...
The importance of submalleolar deformity in determining leg length discrepancy
The Surgeon, 2014
Background and purpose: The association of leg length discrepancy (LLD) with a number of clinical disorders has made its determination a significant part of the physical examination. We believe that submalleolar causes of LLD may be under-acknowledged. The most common clinical method used to measure LLD is by tape from the anterior superior iliac spine (ASIS) to medial malleolus which disregards the potential for LLD arising from asymmetry in the foot distal to the tibiotalar joint. Methods: The present pilot study involves a group of 5 volunteers (experimental group) and a group of 3 patients with flexible flat feet (clinical study). The differences in tibial tubercle height from the ground between full pronation and full supination were measured using the CODA MPX 30 Ò system (Charnwood Dynamics Limited, Leicestershire, England). Correlations of the patterns within each group were produced. Results: A significant relationship with leg lengths was found in the experimental group when they induced maximum pronation (R-squared ¼ 0.62, p ¼ 0.007) while an inverse relationship occurred with supination, although marginally significant (R-squared ¼ 0.37, p ¼ 0.064). Conclusions: We have demonstrated that significant leg length discrepancy can occur in patients who do not have obvious deformity when non weight bearing. We recommend using the blocks method routinely. Appropriately measuring LLD is of vital importance to properly diagnosing and treating patients with unequal leg lengths or related symptoms.
Applied Sciences, 2018
Reducing the effect of leg length discrepancy (LLD) on gait abnormalities while other abnormal conditions such as spasticity, joint contractures or weak muscle strength are exhibited is challenging. This study aimed to evaluate the impact of mild LLD on lower limb biomechanics, on participants with anatomic LLD with and without other clinical abnormalities. A motion capture system was utilized on 32 participants to measure lower limb kinematics and dynamic leg length (DLL) throughout the gait cycle, calculated as the absolute distance from the hip joint center, either to the heel, ankle joint center, or forefoot. The Pearson correlation coefficient found that LLD was associated with 5 kinematic variables only when LLD appeared with no other clinical abnormalities present (r = 0.574-0.846, p < 0.05). When clinical abnormalities were present, the random forest classification accuracy was lower (64% versus 80%), implying that the used kinematics are low predictors for anatomic LLD, revealing a higher asymmetrical clearance index (the difference between the maximal stance phase and the minimal contra-lateral swing phase DLL) and a different kinematic variable importance index. Clinical abnormalities in pathological gait will in all probability significantly affect gait deviations, affirming mild anatomic LLD as inconsequential. A functional measurement can offer a better estimate as to the side and extent of the functional discrepancy.
Leg Length Discrepancy: Assessment and Secondary Effects
Orthopedics and Rheumatology Open Access Journal, 2017
Leg length discrepancy can be noticed commonly in the general population occurring naturally without any secondary side effects it also can be noticed in some patient after surgical treatment of fractures or joint replacement surgery. The presence of this discrepancy can be assessed clinically and can be precisely measured using imaging techniques. LLD can badly affect the lower back, pelvis, hips, knees as well as the gait.
Improvement in gait parameters after lengthening for the treatment of limb-length discrepancy
The Journal of bone and joint surgery. American volume, 1999
Patients who have limb-length discrepancy demonstrate an altered gait pattern or a limp. The purpose of this prospective study was to compare the objective gait parameters for the shorter lower limb with those for the longer lower limb before and after lengthening and to compare these data with those for a group of twenty subjects who had no limb-length discrepancy. Eighteen patients had equalization of limb length to within one centimeter. We analyzed the stance time, the second peak of the vertical ground-reaction-force vector, and the rate of loading with use of two force-plates arranged in a series. The difference in the mean stance times between the shorter and longer limbs before lengthening was 12 percent, whereas that after lengthening was 2.4 percent; the difference between the values before and after lengthening was significant (p<0.001). The difference in the stance times between the limbs of the patients who did not have limb-length discrepancy was 2 percent. Preopera...