Various methods for assessing static lower extremity alignment: implications for prospective risk-factor screenings

Anh-Dung Nguyen, Michelle C. Boling, Carrie A. Slye, Emily M. Hartley, Gina L. Parisi

Research output: Contribution to journalArticlepeer-review

Abstract

Context:
Accurate, efficient, and reliable measurement methods are essential to prospectively identify risk factors for knee injuries in large cohorts.

Objective:
To determine tester reliability using digital photographs for the measurement of static lower extremity alignment (LEA) and whether values quantified with an electromagnetic motion-tracking system are in agreement with those quantified with clinical methods and digital photographs.

Design:
Descriptive laboratory study.

Setting:
Laboratory.

Patients or Other Participants:
Thirty-three individuals participated and included 17 (10 women, 7 men; age = 21.7 ± 2.7 years, height = 163.4 ± 6.4 cm, mass = 59.7 ± 7.8 kg, body mass index = 23.7 ± 2.6 kg/m2) in study 1, in which we examined the reliability between clinical measures and digital photographs in 1 trained and 1 novice investigator, and 16 (11 women, 5 men; age = 22.3 ± 1.6 years, height = 170.3 ± 6.9 cm, mass = 72.9 ± 16.4 kg, body mass index = 25.2 ± 5.4 kg/m2) in study 2, in which we examined the agreement among clinical measures, digital photographs, and an electromagnetic tracking system.

Intervention(s):
We evaluated measures of pelvic angle, quadriceps angle, tibiofemoral angle, genu recurvatum, femur length, and tibia length. Clinical measures were assessed using clinically accepted methods. Frontal- and sagittal-plane digital images were captured and imported into a computer software program. Anatomic landmarks were digitized using an electromagnetic tracking system to calculate static LEA.

Main Outcome Measure(s):
Intraclass correlation coefficients and standard errors of measurement were calculated to examine tester reliability. We calculated 95% limits of agreement and used Bland-Altman plots to examine agreement among clinical measures, digital photographs, and an electromagnetic tracking system.

Results:
Using digital photographs, fair to excellent intratester (intraclass correlation coefficient range = 0.70–0.99) and intertester (intraclass correlation coefficient range = 0.75–0.97) reliability were observed for static knee alignment and limb-length measures. An acceptable level of agreement was observed between clinical measures and digital pictures for limb-length measures. When comparing clinical measures and digital photographs with the electromagnetic tracking system, an acceptable level of agreement was observed in measures of static knee angles and limb-length measures.

Conclusions:
The use of digital photographs and an electromagnetic tracking system appears to be an efficient and reliable method to assess static knee alignment and limb-length measurements.
Original languageAmerican English
Pages (from-to)248–257
JournalJournal of Athletic Training
Volume48
Issue number2
DOIs
StatePublished - Jan 3 2013

Keywords

  • posture
  • risk factor assessment
  • digital photographs

Disciplines

  • Computational Engineering
  • Surgery

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