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Parental perspectives on leg length discrepancy

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Parental perspectives on leg length discrepancy. KM Lee, MD, CY Chung, MD, KH Sung, MD, JH Cho, MD, TW Kim, MD, and MS Park, MD. Seoul National University Bundang Hospital. Introduction. Leg length discrepancy (LLD) - 40 to 70% of population

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Parental perspectives on

leg length discrepancy

KM Lee, MD, CY Chung, MD, KH Sung, MD,

JH Cho, MD, TW Kim, MD, and MS Park, MD

Seoul National University Bundang Hospital

  • Leg length discrepancy (LLD)

- 40 to 70% of population

- associated with low back pain, hip pain, stress fracture

  • How much LLD triggers intervention
  • How to treat with a certain level of LLD
  • Patient’s and parent’s opinion and interest in health related quality of life, dissatisfaction and discomport

LLD of 2cm

- generally accepted guideline for treatment

  • LLD of 2cm in pediatric patients

- shorter leg length

- amount of LLD change in growing children

- difficult to predict subjective psychological impact of LLD

purpose of study
Purpose of study
  • To examine the parental perspectives on their child’s LLD along with the affecting factors including the amount of LLD, patients’ demographics, functional states and health related quality of life

Consecutive patients with chief complaint of LLD over age of 5

  • Exclusion

1) neuromuscular disease, joint contracture, deformity of leg

2) patient who had undergone surgery for LLD


Two groups

- posttraumatic LLD and idiopathic LLD

- LLD<2% and LLD ≥ 2%

  • Pediatric outcomes data collection instrument (PODCI) and LLD questionnaire by parents
  • Teleroentgenograms to measure LLD

Through panel discussion and agreement

  • 34 items for the questionnaire
    • 6 domains: parents’ satisfaction, effect of LLD, preferred treatment, parents’ mood, concern, and expectation regarding treatment
    • 5-point Likert scale: ‘not at all’, ‘slightly’, ‘somewhat’, ‘very’, and ‘extremely’
    • Additional question for willingness to seek treatment

LLD questionnaire


Standing anteroposterior teleroentgenogram

    • Length of both legs: between the summit of the femoral head and the distal articular margin of the tibia
    • Divide the amount of LLD by the long leg length for standardization (%)

Radiographic measurement


Descriptive analysis

  • Spearman’s correlation coefficients

: correlation between the LLD and PODCI

  • t-test or Mann-Whitney U test

: comparison between the two groups

  • Logistic regression analysis

: identification of the significant contributing factors to the willingness to seek treatment

Data analysis


Between the LLD≥2cm and LLD<2cm group

    • Significant differences in their appearance (p=0.012), preference for surgical treatment (p<0.001), effect on happiness (p=0.004), and concerns over possible operation (p=0.010)
‘2cm rule’ can be used to evaluate the parents’ perspectives

Difference in the health related quality of life between idiopathic LLD and posttraumatic LLD

Understanding the parents’ psychological aspects on children’s LLD might enhance communication between surgeons and parents during the decision making