Precision of AI-Based Lower Limb Assessment in Children and Adolescents with Open Growth Plates

Background/Objectives: X-rays are the most reliable and widely available imaging modality for diagnosing deformities of the lower extremities in paediatric orthopaedic patients. This raises the question of whether AI-generated analysis of key parameters is comparable to manual measurement.

Methods

This retrospective, single-center observational study included patients with radiographically confirmed open growth plates at a Level One university hospital in Germany between 2005 and 2022. Using the quality criteria (full-leg weight-bearing radiograph with the patella centered, showing both legs with the upper ankle joint and pelvis, in a bipedal, hip-width stance), 325 X-rays were evaluated for leg length measurement and 269 X-rays for leg angle measurement. For each parameter, measurements were taken manually by a specialist and compared with the results from the AI software BoneMetrics developed by Gleamer (Paris, France). The age range of the patients at the time of examination was for length measurements between 3.4 and 17.8 years; 59.4% were male (mean 12.5 ± 3.0 years) and 40.6% were female (mean 10.8 ± 2.8 years). For angle measurements, the study included a cohort ranging in age from 10.1 to 17.7 years; 58% were male (mean age 13.6 ± 1.7 years) and 42% were female (mean age 12.5 ± 1.4).