Skip to main content
SpringerLink
Log in

Limb Lengthening and Reconstruction Society AIM Index Reliably Assesses Lower Limb Deformity

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Although several systems exist for classifying specific limb deformities, there currently are no validated rating scales for evaluating the complexity of general lower limb deformities. Accurate assessment of the complexity of a limb deformity is essential for successful treatment. A committee of the Limb Lengthening and Reconstruction Society (LLRS) therefore developed the LLRS AIM Index to quantify the severity of a broad range of lower extremity deformities in seven domains.

Questions/Purposes

We addressed two questions: (1) Does the LLRS AIM Index show construct validity by correlating with rankings of case complexity? (2) Does the LLRS AIM Index show sufficient interrater and intrarater reliabilities?

Methods

We had eight surgeons evaluate 10 fictionalized patients with various lower limb deformities. First, they ranked the cases from simplest to most complex, and then they rated the cases using the LLRS AIM Index. Two or more weeks later, they rated the cases again. We assessed reliability using the Kendall’s W test.

Results

Raters were consistent in their rankings of case complexity (W = 0.33). Patient rankings also correlated with both sets of LLRS AIM ratings (r2 = 0.25; r2 = 0.23). The LLRS AIM Index showed interrater reliability with an intraclass correlation (ICC) of 0.97 for Trial 1 and 0.98 for Trial 2 and intrarater reliability with an ICC of 0.94. The LLRS AIM Index ratings also were highly consistent between the attending surgeons and surgeons-in-training (ICC = 0.91).

Conclusions

Our preliminarily observations suggest that the LLRS AIM Index reliably classifies the complexity of lower limb deformities in and between observers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Achterman C, Kalamchi A. Congenital deficiency of the fibula. J Bone Joint Surg Br. 1979;61:133–137.

    PubMed  Google Scholar 

  2. Aitken GT. Proximal femoral focal deficiency: definition, classification, and management. In: Aitken GT, ed. Proximal Femoral Focal Deficiency: A Congenital Anomaly. Washington, DC: National Academy of Sciences; 1969:1–22.

    Google Scholar 

  3. Andersen KS. Radiological classification of congenital pseudarthrosis of the tibia. Acta Orthop Scand. 1973;44:719–727.

    Article  PubMed  CAS  Google Scholar 

  4. Bhave A, Paley D, Herzenberg JE. Improvement in gait parameters after lengthening for the treatment of limb-length discrepancy. J Bone Joint Surg Am. 1999;81:529–534.

    PubMed  CAS  Google Scholar 

  5. Birch JG, Lincoln TL, Mack PW, Birch CM. Congenital fibular deficiency: a review of thirty years’ experience at one institution and a proposed classification system based on clinical deformity. J Bone Joint Surg Am. 2011;93:1144–1151.

    Article  PubMed  Google Scholar 

  6. Boyd HB. Pathology and natural history of congenital pseudarthrosis of the tibia. Clin Orthop Relat Res. 1982;166:5–13.

    PubMed  Google Scholar 

  7. Brouwer GM, van Tol AW, Bergink AP, Belo JN, Bernsen RM, Reijman M, Pols HA, Bierma-Zeinstra SM. Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheum. 2007;56:1204–1211.

    Article  PubMed  CAS  Google Scholar 

  8. Catagni MA, Guerreschi F, Manzotti A, Knuth A. Treatment of foot deformities using the Ilizarov method. Foot Ankle Surg. 2000;6:207–237.

    Article  Google Scholar 

  9. Catagni MA, Radwan M, Lovisetti L, Guerreschi F, Elmoghazy NA. Limb lengthening and deformity correction by the Ilizarov technique in type III fibular hemimelia: an alternative to amputation. Clin Orthop Relat Res. 2011;469:1175–1180.

    Article  PubMed  Google Scholar 

  10. Crawford AH. Neurofibromatosis in children. Acta Orthop Scand Suppl. 1986;218:1–60.

    PubMed  CAS  Google Scholar 

  11. Hamanashi C. Congenital vertical talus: classification with 69 cases and new measurement system. J Pediatr Orthop. 1984;4:318–326.

    Article  Google Scholar 

  12. Hefti F, Brunner R, Freuler F, Hasler C, Jundt G. Pediatric Orthopedics in Practice. Berlin, Germany: Springer; 2007.

    Google Scholar 

  13. Jones D, Barnes J, Lloyd-Roberts GC. Congenital aplasia and dysplasia of the tibia with intact fibula: classification and management. J Bone Joint Surg Br. 1978;60:31–39.

    PubMed  CAS  Google Scholar 

  14. Kalamchi A, Dawe RV. Congenital deficiency of the tibia. J Bone Joint Surg Br. 1985;67:581–584.

    PubMed  CAS  Google Scholar 

  15. Kaufman KR, Miller LS, Sutherland DH. Gait asymmetry in patients with limb-length inequality. J Pediatr Orthop. 1996;16:144–150.

    Article  PubMed  CAS  Google Scholar 

  16. McCarthy JJ, MacEwen GD. Management of leg length inequality. J South Orthop Assoc. 2001;10:73–85; discussion 85.

    PubMed  CAS  Google Scholar 

  17. Paley D. Lengthening reconstruction surgery for congenital femoral deficiency. In: Herring JA, Birch JG, eds. The Child with a Limb Deficiency. Rosemont, IL: American Academy of Orthopaedic Surgeons; 1998:113–132.

    Google Scholar 

  18. Paley D, Bhave A, Herzenberg JE, Bowen JR. Multiplier method for predicting limb-length discrepancy. J Bone Joint Surg Am. 2000;82:1432–1446.

    PubMed  Google Scholar 

  19. Pappas AM. Congenital abnormalities of the femur and related lower extremity malformations: classification and treatment. J Pediatr Orthop. 1983;3:45–60.

    Article  PubMed  CAS  Google Scholar 

  20. Sabharwal S, Zhao C. The hip-knee-ankle angle in children: reference values based on a full-length standing radiograph. J Bone Joint Surg Am. 2009;91:2461–2468.

    Article  PubMed  Google Scholar 

  21. Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86:420–428.

    Article  PubMed  CAS  Google Scholar 

  22. Song KM, Halliday SE, Little DG. The effect of limb-length discrepancy on gait. J Bone Joint Surg Am. 1997;79:1690–1698.

    Article  PubMed  CAS  Google Scholar 

  23. Stanitski DF. Limb-length inequality: assessment and treatment options. J Am Acad Orthop Surg. 1999;7:143–153.

    PubMed  CAS  Google Scholar 

  24. Stanitski DF, Stanitski CL. Fibular hemimelia: a new classification system. J Pediatr Orthop. 2003;23:30–34.

    PubMed  Google Scholar 

  25. Torode IP, Gillespie R. The classification and treatment of proximal femoral deficiencies. Prosthet Orthot Int. 1991;15:117–126.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank the members of the Limb Lengthening and Reconstruction Society and John G. Birch, MD, David J. Klimaski MD, Viral Jain MD, Nathan Faulkner MD, and Esther Cheng BS for their guidance and assistance with this research project and article.

Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, ML 2017, Cincinnati, OH, 45229, USA

    James J. McCarthy MD

  2. Department of Orthopaedics, Miami Children’s Hospital, Miami, FL, USA

    Christopher A. Iobst MD

  3. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA

    S. Robert Rozbruch MD

  4. Department of Orthopaedics, New Jersey Medical School, University of Medicine & Dentistry of New Jersey, Newark, NJ, USA

    Sanjeev Sabharwal MD

  5. Division of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Emily A. Eismann MS

Authors
  1. James J. McCarthy MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher A. Iobst MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Robert Rozbruch MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sanjeev Sabharwal MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Emily A. Eismann MS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James J. McCarthy MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

This work was performed at Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 2,721 kb)

About this article

Cite this article

McCarthy, J.J., Iobst, C.A., Rozbruch, S.R. et al. Limb Lengthening and Reconstruction Society AIM Index Reliably Assesses Lower Limb Deformity. Clin Orthop Relat Res 471, 621–627 (2013). https://doi.org/10.1007/s11999-012-2609-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-012-2609-8

Keywords

Search

Navigation