Skeletal assessment and secular changes in knee development: a radiographic approach

Area of Science:

• Pediatric Radiology
• Anthropology
• Human Growth and Development

Background:

• Skeletal maturation and ossification patterns are crucial for age estimation in children.
• Existing standards for skeletal age assessment, such as those by Elgenmark and Garn et al., may not reflect current growth patterns in contemporary American populations.
• Accurate age estimation is vital for clinical and forensic applications.

Purpose of the Study:

• To analyze ossification patterns of the distal femoral, proximal tibial, proximal fibular epiphyses, and patella in contemporary American children.
• To compare current ossification timing with established historical standards.
• To determine if existing clinical and skeletal age assessment standards require updates for modern American youth.

Main Methods:

• Radiographs of 1,056 white individuals born after 1990 were analyzed using the Pediatric Radiology Interactive Atlas (Patricia).
• A total of 1,317 epiphyses were scored for presence or absence.
• Logistic regression was used for statistical modeling of epiphyseal appearance across major percentiles (5th and 95th).

Main Results:

• Ossification of the distal femoral and proximal tibial epiphyses appears earlier in contemporary children compared to historical data.
• Ossification of the proximal fibular epiphysis occurs later in contemporary children.
• Specific timing differences include distal femoral epiphysis (1.2 weeks earlier), proximal tibial epiphysis (2.1 weeks earlier), and proximal fibular epiphysis (1.4 years later) at the 50th percentile.

Conclusions:

• Significant differences exist between current ossification timing and previously established standards, necessitating updated growth standards.
• Gestational age information is important for accurately estimating the appearance times of early-ossifying epiphyses like the distal femoral.
• Factors such as improved prenatal care, socioeconomic status, and secular changes may contribute to observed shifts in skeletal maturation patterns.