Department of Orthopaedic Surgery and Sports Medicine, Shriners Children's Lexington, University of Kentucky, Lexington, Kentucky.
Texas Scottish Rite Hospital for Children, Dallas, Texas.
J Bone Joint Surg Am. 2024 Jan 17;106(2):145-150. doi: 10.2106/JBJS.23.00286. Epub 2023 Nov 16.
The Modified Fels (mFels) and Abbreviated Modified Fels (abFels) knee systems have been recently developed as options for grading skeletal maturity without the need for a separate hand radiograph. We sought to determine the interobserver reliability of these systems and to compare their prediction accuracy with that of the Greulich and Pyle (G-P) atlas in a cohort managed with epiphysiodesis for leg-length discrepancy (LLD).
Three reviewers scored 20 knee radiographs using the mFels system, which includes 5 qualitative and 2 quantitative measures as well as a quantitative output. Short leg length (SL), long leg length (LL), and LLD prediction errors at maturity using the White-Menelaus (W-M) method and G-P, mFels, or abFels skeletal age were compared in a cohort of 60 patients managed with epiphysiodesis for LLD.
Intraclass correlation coefficients for the 2 quantitative variables and the quantitative output of the mFels system using 20 knee radiographs ranged from 0.55 to 0.98, and kappa coefficients for the 5 qualitative variables ranged from 0.56 to 1, indicating a reliability range from moderate to excellent. In the epiphysiodesis cohort, G-P skeletal age was on average 0.25 year older than mFels and abFels skeletal ages, most notably in females. The majority of average prediction errors between G-P, mFels, and abFels were <0.5 cm, with the greatest error being for the SL prediction in females, which approached 1 cm. Skeletal-age estimates with the mFels and abFels systems were statistically comparable.
The mFels skeletal-age system is a reproducible method of determining skeletal age. Prediction errors in mFels and abFels skeletal ages were clinically comparable with those in G-P skeletal ages in this epiphysiodesis cohort. Further work is warranted to optimize and validate the accuracy of mFels and abFels skeletal ages to predict LLD and the impact of epiphysiodesis, particularly in females. Both the mFels and abFels systems are promising means of estimating skeletal age, avoiding additional radiation and health-care expenditure.
Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.
改良费尔斯（mFels）和简化改良费尔斯（abFels）膝关节系统最近被开发出来，作为无需单独拍摄手部 X 光片即可评估骨骼成熟度的选择。我们旨在确定这些系统的观察者间可靠性，并在接受骺板切除术治疗肢体长度差异（LLD）的患者队列中比较它们与 Greulich 和 Pyle（G-P）图谱的预测准确性。
三名审阅者使用 mFels 系统对 20 张膝关节 X 光片进行评分，该系统包括 5 项定性和 2 项定量测量以及一项定量输出。在接受骺板切除术治疗 LLD 的 60 例患者队列中，使用 White-Menelaus（W-M）法和 G-P、mFels 或 abFels 骨骼年龄比较了 SL（短肢）、LL（长肢）和成熟期 LLD 预测误差。
使用 20 张膝关节 X 光片，mFels 系统的 2 个定量变量和定量输出的组内相关系数范围为 0.55 至 0.98，5 个定性变量的kappa 系数范围为 0.56 至 1，表明可靠性范围从中等到优秀。在骺板切除术队列中，G-P 骨骼年龄平均比 mFels 和 abFels 骨骼年龄大 0.25 岁，在女性中尤为明显。G-P、mFels 和 abFels 之间的大多数平均预测误差<0.5 cm，最大误差为女性的 SL 预测，接近 1 cm。mFels 和 abFels 系统的骨骼年龄估计在统计学上是可比的。
mFels 骨骼年龄系统是一种可重复的确定骨骼年龄的方法。在骺板切除术队列中，mFels 和 abFels 骨骼年龄的预测误差在临床上与 G-P 骨骼年龄的预测误差相当。需要进一步的工作来优化和验证 mFels 和 abFels 骨骼年龄预测 LLD 和骺板切除术影响的准确性，特别是在女性中。mFels 和 abFels 系统都是估计骨骼年龄的有前途的方法，可以避免额外的辐射和医疗支出。
预后水平 II。请参阅作者说明以获取完整的证据水平描述。
