Skeletal maturity as a biomarker for determining indications for regenerative interventional technologies in adolescent patients with hip and knee diseases
Authors:   State Institute of Traumatology and Orthopedics, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine, Filipchuk V. , Strafun S. ,   State Institute of Traumatology and Orthopedics, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine, Holiuk Ye. ,   State Institute of Traumatology and Orthopedics, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine, Melnyk M. ,   State Institute of Traumatology and Orthopedics, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
Published: July 2023

Our preliminary studies indicate the significant value of assessing skeletal maturity in adolescents, which characterizes the development of the skeleton in an individual and can be used as a biomarker of regenerative potential in children and adolescents, which significantly affects the choice of treatment tactics for diseases of the hip and knee joints. In particular, we have established the dependence of reparative regeneration processes in children and adolescents on skeletal maturity in such diseases of the hip and knee joints as slipped capital of femoral epiphysis (SCFE), Perthes’ disease, femoro-acetabular conflict syndrome, spastic hip dislocation in patients with cerebral palsy, Blount’s disease. The intensity of regeneration processes in the prepubertal development allows the use of less invasive methods of surgical interventions. The purpose is to develop a methodology for determining skeletal maturity as a biomarker for establishing indications for regenerative interventional technologies in adolescent patients with hip and knee joint diseases. Materials and methods. The group for the development of the examination methodology consisted of 157 patients (86 boys and 71 girls) with hip joint pathology (hip dysplasia, Perthes disease, juvenile epiphysiolysis of the femoral head, aseptic necrosis of the femoral head, and without diagnosed hip joint pathology) and 129 patients (58 boys and 71 girls) with knee joint diseases (Blount disease, axial deformities of the lower extremities, meniscal damage and patients who were examined for complaints of pain in the knee joint area) aged 10 to 18 years. The group of a differentiated approach to the use of regenerative interventional technologies consisted of 46 adolescent patients with diseases of the hip and knee joints (SCFE, Perthes’ disease, Blount’s disease, the pathology of menisci). Results. A methodology for the use of skeletal maturity as a biomarker for establishing indications for regenerative interventional technologies in adolescent patients with diseases of the hip and knee joints has been developed, which includes the following steps: establishing the period of sexual development of the patient based on the determination of skeletal maturity based on radiographs of the hip and knee joints, establishing additional risk factors (heredity, individual characteristics of the connective tissue, the presence of chronic systemic diseases) and the severity of the disease (according to the results of questionnaires). According to the results of the analysis of the application of the methodology of distinguishing skeletal maturity as a biomarker of indications for regenerative interventional technologies in adolescent patients with diseases of the hip and knee joints, it was established that in prepuberty only 3 out of 16 examined patients (which amounted to 19%) have indications for regenerative interventional technologies, during the induction of puberty, 4 out of 9 examined patients (that is, almost 50%) had the indicated indications. Our preliminary studies indicate the significant value of assessing skeletal maturity in adolescents, as it characterizes the development of the skeleton in an individual and can serve as a biomarker for regenerative potential in children and adolescents. This assessment significantly influences the choice of treatment tactics for diseases of the hip and knee joints. Specifically, we have established a correlation between reparative regeneration processes and skeletal maturity in conditions such as slipped capital femoral epiphysis (SCFE), Perthes' disease, femoroacetabular impingement syndrome, spastic hip dislocation in patients with cerebral palsy, and Blount's disease. The intensity of regeneration processes during prepubertal development allows for the use of less invasive methods of surgical interventions. The purpose of the study was to develop a methodology for determining skeletal maturity as a biomarker for establishing indications for regenerative interventional technologies in adolescent patients with hip and knee joint diseases. Materials and methods. The study group for the development of the examination methodology included 157 patients (86 boys and 71 girls) with hip joint pathology (hip dysplasia, Perthes' disease, juvenile epiphysiolysis of the femoral head, aseptic necrosis of the femoral head, and individuals without diagnosed hip joint pathology), as well as 129 patients (58 boys and 71 girls) with knee joint diseases (Blount's disease, axial deformities of the lower extremities, meniscal damage, and patients who were examined due to complaints of knee joint pain), aged between 10 to 18 years. The group for a differentiated approach to the use of regenerative interventional technologies consisted of 46 adolescent patients with diseases of the hip and knee joints (SCFE, Perthes' disease, Blount's disease, and pathology of menisci). Results. A methodology for the use of skeletal maturity as a biomarker for establishing indications for regenerative interventional technologies in adolescent patients with diseases of the hip and knee joints has been developed, which includes the following steps: establishing the period of sexual development of the patient based on the determination of skeletal maturity based on radiographs of the hip and knee joints, establishing additional risk factors (heredity, individual characteristics of the connective tissue, the presence of chronic systemic diseases) and the severity of the disease (according to the results of questionnaires). According to the results of the analysis of the application of the methodology of distinguishing skeletal maturity as a biomarker of indications for regenerative interventional technologies in adolescent patients with diseases of the hip and knee joints, it was established that in prepuberty only 3 out of 16 examined patients (which amounted to 19%) have indications for regenerative interventional technologies, during the induction of puberty, 4 out of 9 examined patients (that is, almost 50%) had the indicated indications. Conclusions. In the prepubertal period, we recommend the use of regenerative technologies in combination with one of the risk factors or in cases with a severe or moderate course of the disease. During the induction of puberty, regenerative technologies are recommended in the presence of one of the risk factors or in cases with a severe or moderate course of the disease. In the pubertal period, due to the reduction of the individual's regenerative potential, we recommend the use of regenerative technologies for all patients.