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MR imaging in congenital lower limb deformities
T Laor1, D Jaramillo, F A Hoffer
1Department of Radiology, Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
Insights
MR imaging reveals numerous osteochondral and soft tissue abnormalities in children with congenital lower extremity deformities, aiding surgical planning. This advanced imaging detects issues missed by conventional radiography for better treatment outcomes.
Area of Science:
- Pediatric Orthopedics
- Medical Imaging
- Radiology
Background:
- Congenital lower extremity deformities require precise diagnosis for effective treatment.
- Conventional radiography has limitations in visualizing soft tissue and subtle osteocartilaginous abnormalities.
Purpose of the Study:
- To illustrate the range of osteochondral and extrasosseous abnormalities in pediatric lower extremity deformities using Magnetic Resonance (MR) imaging.
- To highlight the diagnostic value of MR imaging in cases of fibular hemimelia, tibial hemimelia, and congenital constriction bands.
Main Methods:
- Retrospective review of MR examinations in 13 limbs of 10 children (1 month to 9 years) with congenital lower extremity deformities.
- Detailed assessment of osteocartilaginous structures and extraosseous components including ligaments, tendons, menisci, muscles, and arteries.
Main Results:
- All patients exhibited abnormalities; MR imaging identified significant osteocartilaginous issues (e.g., abnormal epiphyses, bone remnants, tarsal anomalies) in longitudinal deformities.
- No osteocartilaginous abnormalities were noted in constriction band cases.
- Frequent articular abnormalities (cruciate ligaments, menisci, patellae, tendons) and vascular anomalies (popliteal artery) were observed in hemimelia cases.
Conclusions:
- MR imaging demonstrates a wide spectrum of osteochondral and extrasosseous abnormalities in congenital lower extremity deformities, often undetected by radiography.
- This comprehensive visualization aids in planning early surgical interventions and prosthetic rehabilitation for improved patient outcomes.
Abstract:
Treatment for children with congenital deformities of the lower extremities may vary, depending on the state of the unossified skeletal structures and surrounding soft tissues. The purpose of our study was to demonstrate the spectrum of the osteochondral and extrasosseous abnormalities as depicted with MR imaging. We retrospectively reviewed MR examinations of 13 limbs of ten children (aged 1 month-9 years, mean 2.1 years) with longitudinal and transverse deformities of the lower extremities. The lesions imaged were fibular hemimelia (n = 5), tibial hemimelia (n = 5), and congenital constriction bands (n = 3). Each examination was assessed for abnormalities in the osteocartilaginous and extraosseous (articular or periarticular components such as ligaments, tendons, and menisci; the muscles and the arteries) structures. Abnormalities were seen in all patients. Osteocartilaginous abnormalities in the patients with longitudinal deformities included abnormal distal femoral epiphyses, abnormal proximal tibial physes, hypertrophied and dislocated proximal fibular epiphyses, unsuspected fibular and tibial remnants, and absence or coalition of the tarsal bones. No osteocartilaginous abnormalities were seen in the patients with congenital constriction bands. Articular abnormalities about the knee in patients with either form of hemimelia included absent cruciate ligaments and menisci, dislocated or absent cartilaginous patellae, absent patellar tendons, and abnormal collateral ligaments. All but one limb imaged had absent or attenuated muscle groups. Of the nine MR arteriograms performed at the level of the knee, eight were abnormal. The normal popliteal trifurcation was absent or in an abnormal location. We conclude that MR imaging of children with congenital lower extremity deformities shows many osteochondral and extraosseous abnormalities that are not depicted by conventional radiography. This information can help to plan early surgical intervention and prosthetic rehabilitation.