Study design: Descriptive radiographic analysis of a prospective multi-center database. Objective: This study aims to provide normative values of spinopelvic parameters and their correlations according to age and pelvic incidence (PI) of subjects without spinal deformity. Methods: After Institutional Review Board (IRB) approval, 1540 full spine radiographs were analyzed. Subjects were divided into 3 groups of PI: low PI < 45 degrees, intermediate PI 45-60 degrees, high PI > 60 degrees, and then stratified by age (20-34, 35-49, 50-64, > 65 Y.0). Pelvic and spinal parameters were measured. Statistical analysis between parameters was performed using Bayesian inference and correlation. Results: Mean age was 53.5 years (845 females, 695 males, range 20-93 years). In low PI group, lumbar lordosis (LL) decrease was mainly observed in the 2 younger age groups. In medium and high PI groups, loss of lordosis was linear during aging and occurred mainly on the distal arch of lordosis. Moderate PI group had a stable lordosis apex and thoracolumbar inflection point. High PI group had a stable thoracolumbar inflection point and a more distal lordosis apex in elderly subjects. For all subjects, kyphosis and pelvic tilt (PT) increased with age. There was a constant chain of correlation between PI and age groups. Proximal lumbar lordosis (PLL) was correlated with kyphosis and sagittal vertical axis (SVA C7), while the distal lumbar lordosis (DLL) was correlated with PI and PT. Conclusion: This study provides a detailed repository of sagittal spinopelvic parameters normative values with detailed analysis of segmental kyphosis and lordosis distribution according to gender, age, and PI.

Study design Descriptive radiographic analysis of a prospective multi-center database. Objective This study aims to provide normative values of spinopelvic parameters and their correlations according to age and pelvic incidence (PI) of subjects without spinal deformity. Methods After Institutional Review Board (IRB) approval, 1540 full spine radiographs were analyzed. Subjects were divided into 3 groups of PI: low PI < 45°, intermediate PI 45–60°, high PI > 60°, and then stratified by age (20–34, 35–49, 50–64, > 65 Y.O). Pelvic and spinal parameters were measured. Statistical analysis between parameters was performed using Bayesian inference and correlation. Results Mean age was 53.5 years (845 females, 695 males, range 20–93 years). In low PI group, lumbar lordosis (LL) decrease was mainly observed in the 2 younger age groups. In medium and high PI groups, loss of lordosis was linear during aging and occurred mainly on the distal arch of lordosis. Moderate PI group had a stable lordosis apex and thoracolumbar inflection point. High PI group had a stable thoracolumbar inflection point and a more distal lordosis apex in elderly subjects. For all subjects, kyphosis and pelvic tilt (PT) increased with age. There was a constant chain of correlation between PI and age groups. Proximal lumbar lordosis (PLL) was correlated with kyphosis and sagittal vertical axis (SVA C7), while the distal lumbar lordosis (DLL) was correlated with PI and PT. Conclusion This study provides a detailed repository of sagittal spinopelvic parameters normative values with detailed analysis of segmental kyphosis and lordosis distribution according to gender, age, and PI.

Study Design. Retrospective cross-sectional study. Objective. The aim was to describe spinopelvic alignment types by pelvic incidence (PI) and age to compare the Roussouly classification between pediatric and adult populations. Summary of Background Data. The Roussouly classification was validated for adults. Alignment types may vary during growth. Materials and Methods. Radiographs of 1706 non pathologic individuals (5–49 yr) were analyzed. Individuals ≤19 years were stratified by chronological age and skeletal maturity (triradiate cartilage, Risser), and compared with adults. Global and spinopelvic alignment parameters were assessed. Roussouly Types 1, 2, 3, 3A (anteverted pelvis), and 4 were determined. The distribution of parameters was analyzed by Bayesian inference. The relationship between PI and age by Roussouly type was modeled by linear regression. Results. The Sagittal Vertical Axis C7 decreased during growth and was significantly smaller in adults (20–34 yr) (Pr>0.99). Thoracic kyphosis and lumbar lordosis increased during growth and were larger in adults (Pr<0.025). Lordosis increased mainly in the cranial arch (Pr<0.025). PI and pelvic tilt increased during growth and were larger in adults (Pr<0.025). In children and adolescents, PI<45° represented the largest proportion, significantly larger compared with adults (Pr>0.99). Proportions of Roussouly Types 1 and 2 were similar throughout ages. Types 3 and 4 were rarer during the prepubertal period (Pr<0.025). The proportion of Type 3A was significantly higher in children and adolescents (Pr>0.99). Linear regression showed that Type 4 had the largest PI increase with age, with significantly higher curve slope compared with other types (Pr>0.9999). Types 3, 3A and 2 had similar slopes and lowest PI increase with age. Conclusion. Global and spinopelvic alignment changed during childhood and adolescence, leading to different kyphosis and lordosis distribution compared with adults. Growth-related PI increase influenced Roussouly types with typical predominance of Type 3A in the pediatric population and larger PI increase in Type 4. Level of Evidence. Level III.

Study design National cross-sectional study. Objective Thoracic kyphosis (TK) is related to sagittal parameters as pelvic tilt (PT), lumbar lordosis (LL) and pelvic incidence (PI). The equation TK = 2 (PT+LL–PI) was validated for adolescents. The purpose of this study was to investigate if this equation correctly predicts TK regardless of age. Methods Sagittal alignment parameters were assessed on full spine radiographs of 2599 individuals without spine pathology (1488 females, 1111 males). Calculated TK (CTK) = 2 (PT+LL–PI) and measured TK (MTK) were compared by calculating the gap and using a linear regression between both parameters. Subgroup analyses were performed for gender, age, TK groups (≤20°, 21°-40°, 41°-60°, >60°), and PI groups (<45°, 45°-60°, >60°). Results Average values in the total population were: MTK 45.0°, CTK 36.9°. Average TK gap was 8.1°, 5.2° in females (intercept 11.7, slope .61) and 11.9° in males (intercept 7.1, slope .58). The mean gap was 3.6° for 15-34 years, 5.7° under 15 years and it increased progressively after 35 years with a maximum of 19.9° over 80 years. The gap also increased with the amount of MTK: -3.5° for TK<20° up to 17.3° for TK >60°. Differences in gaps were minor between PI groups. The intercept was smallest and slopes >.6 for PI <45° and TK ≤20°. Conclusion The formula TK=2 (PT+LL-PI) yielded moderate accuracy for adolescents and young adults, but did not fit for over 35 years and under 15. The amount and variance in TK increased in elderly subjects, which made the formula less accurate.

Le relèvement de la berge latérale de trochlée, première technique de trochléoplastie décrite, a été progressivement abandonné au profit d’autres interventions pour le traitement de l’instabilité fémoropatellaire avec dysplasie trochléenne. Les résultats à très long terme sont rarement analysés. L’objectif de cette étude rétrospective était d’évaluer les résultats cliniques (récidive d’instabilité, score fonctionnels) et radiologiques (arthrose fémoropatellaire). À long terme, la trochléoplastie de relèvement donne un faible taux de récidive de luxation fémoropatellaire et ne s’accompagne pas d’arthrose fémoropatellaire sévère. Cinquante-huit patients (66 genoux) ont eu une trochléoplastie de relèvement entre 1988 et 1995 pour instabilité fémoropatellaire avec dysplasie de trochlée. La cohorte étudiée dans notre étude était composée des 17 genoux (13 patients) ayant pu être revus à 16 et 25 ans de recul moyen. Ils ont été évalués selon des critères cliniques (stabilité, douleur), fonctionnels (score Lillois) et radiologiques (évolution des clichés radiographiques et tomodensitométriques). Quatre genoux avaient eu une plastie du vaste médial selon Insall, 9 une plastie du sartorius et 7 genoux n’avaient pas eu de geste sur la TTA. Aucune récidive de luxation fémoropatellaire n’a été observée à 25 ans. Le score fémoropatellaire Lillois moyen était de 90 ± 15 [48–99] à 16 ans, et de 86 ± 23 [33–94] à 25 ans. À16 ans, 7/17 genoux présentaient une arthrose fémoropatellaire stade 1 selon Iwano et un seul genou présentait un stade 2. À 25 ans, un seul genou était indemne d’arthrose fémoropatellaire mais 8 genoux sur 13 avaient une arthrose peu évoluée (1 et 2 d’Iwano). À 25 ans, 4/17 genoux avaient été repris par des prothèses : 2 fémoropatellaires et 2 prothèses totales. Cette intervention est fiable et durable dans le traitement de l’instabilité fémoropatellaire avec dysplasie prévenant les récidives de luxation et donnant des scores fonctionnels favorables. Contrairement à ce qui a été avancé, elle ne donne pas lieu à des taux élevés d’arthrose sévère même au-delà de 20 ans de recul. IV, étude rétrospective sans groupe contrôle.

Background: Lateral wedge augmentation trochleoplasty (LWAT) was the earliest described trochleoplasty technique but was gradually replaced by other methods for the treatment of patello-femoral instability with trochlear dysplasia. Data on the outcomes of this procedure in adults are limited. We therefore performed a retrospective study in patients managed by LWAT to assess (1) clinical (recurrent instability and functional scores), (2) and radiological (patello-femoral osteoarthritis) outcomes. Hypothesis: LWAT is associated with a low long-term rate of recurrent patello-femoral dislocation and with no risk of progression to severe patello-femoral osteoarthritis. Material and methods: Between 1988 and 1995, LWAT was performed on 66 knees in 58 patients to treat patello-femoral instability with trochlear dysplasia. Among them, 17 knees in 13 patients were reevaluated 16 then 25 years after surgery and were included in the study. At both time points, the following were recorded: stability, pain, the Lille patello-femoral function score, and changes in radiographic and computed tomography findings. In addition to LWAT, Insall's realignment vastus medialis advancement was performed in 4 cases, sartorius muscle transposition in 9 cases, and anterior tibial tubercle osteotomy in 10 cases. Results: No episodes of patello-femoral dislocation were recorded during the 25 -year follow-up. The mean Lille patello-femoral function score (0 worst to 100 highest) was 90 +/- 15 (range, 48-99) after 16 years and 86 +/- 23 (range, 33-94) after 25 years. After 16 years, 8/17 knees had evidence of patellofemoral osteoarthritis, which was Iwano stage 1 in 7 cases and Iwano stage 2 in 1 case. Patello-femoral osteoarthritis was noted in 12 of 13 knees after 25 years but was mild (Iwano stage 1 or 2) in 8 cases. After 25 years, arthroplasty had been performed for 4 of the 17 knees, with 2 cases each of patello-femoral arthroplasty and total knee arthroplasty. Conclusion: LWAT is a reliable procedure that provides sustained protection against patello-femoral dislocation and good functional scores when used to treat patello-femoral instability due to trochlear dysplasia. Our results do not support claims that LWAT may be associated with high rates of severe osteoarthritis even after more than 20 years. Level of evidence: IV, retrospective observational study with no control group. (C) 2019 Published by Elsevier Masson SAS.