A new method for measuring structural limb-length discrepancy : A quasi-experimental study

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Atallah, Huthaifa and Qufabz, Titeana and Alfatafta, Mahmoud and Alshawabka, Amneh and Yasin, Mohamad Samih and Samarah, Omar Q. and McGarry, Anthony and Molics, Bálint (2026) A new method for measuring structural limb-length discrepancy : A quasi-experimental study. Journal of Clinical Medicine, 15 (11). 4309. ISSN 2077-0383 (https://doi.org/10.3390/jcm15114309)

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Abstract

Background/Objectives: Limb-length discrepancy (LLD) is a relatively common condition, with structural LLD characterized by true shortening of a bony structure. Although various clinical and radiological methods are available, none rely exclusively on position of malleoli relative to one another. This study aims to introduce a novel method for measuring structural LLD using malleoli in conjunction with a ruler. A quasi-experimental study. Methods: Eighteen participants with structural LLD were recruited from an orthopaedic clinic. Each participant underwent four tests: Paired Medial Malleolus Level Test (PMMLT) (new method), measuring tape method (Anterior Superior Iliac Spine (ASIS) to Medial Malleoli (MM), standing-block test, and full-length standing (long bone) radiography. Validity was assessed against radiography. Results: The mean ± SD LLD measured by radiography was 2.99 ± 1.69 cm. Corresponding values were obtained with the PMMLT (2.98 ± 1.69 cm), measuring tape method (2.95 ± 1.66 cm), and the standing-block test (2.92 ± 1.73 cm). No significant differences were found among the methods (χ2(3) = 3.43, p = 0.330). Correlations with radiography were very strong (PMMLT r = 0.996; measuring tape method r = 0.990; standing-block test r = 0.991; all p < 0.001). PMMLT showed negligible bias (−0.01 cm), the narrowest 95% limits of agreement (−0.32 to 0.30 cm), and the lowest RMSE (0.15 cm). Conclusions: The PMMLT demonstrates accuracy and practicality while being simple, cost-effective, and free of radiation exposure, making it a valuable alternative for clinical assessment of LLD in settings where imaging is unavailable or contraindicated.

ORCID iDs

Atallah, Huthaifa, Qufabz, Titeana, Alfatafta, Mahmoud, Alshawabka, Amneh, Yasin, Mohamad Samih, Samarah, Omar Q., McGarry, Anthony ORCID logoORCID: https://orcid.org/0000-0002-0738-5906 and Molics, Bálint;
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