Application of a machine learning and optimization method to predict patellofemoral instability risk factors in children and adolescents

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-07-21 DOI:10.1002/ksa.12372

Yoon Hae Kwak, Yu Jin Ko, Hyunjae Kwon, Yong-Gon Koh, Amaal M. Aldosari, Ji-Hoon Nam, Kyoung-Tak Kang

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引用次数: 0

Abstract

Purpose

Conservative treatment remains the standard approach for first-time patellar dislocations. While risk factors for patellofemoral instability, a common paediatric injury, are well-established in adults, data concerning the progression of paediatric recurrent patellar dislocation remain scarce. A reproducible method was developed to quantitatively assess the patellofemoral morphology and anatomic risk factors in paediatric patients using magnetic resonance imaging (MRI) and machine learning analysis.

Methods

Data were analyzed from a retrospective review (2005–2022) of paediatric patients diagnosed with acute lateral patellar dislocation (54 patients) who underwent MRI and were compared with an age-based control group (54 patients). Patellofemoral, tibial, tibiofemoral and patellar height parameters were measured. Differences between groups were analyzed with respect to MRI parameters. The potential diagnostic utility of the parameters was assessed via machine learning and genetic algorithm analyses.

Results

Significant differences were observed between the two groups in six patellofemoral morphological parameters. Regarding patellar height morphological parameters, all methods exhibited significant between-group differences. Among the tibia and tibiofemoral morphological parameters, only the tibial tubercle–trochlear groove distance exhibited significant differences between the two groups. No sex-related differences were present. Significant variations were observed in patellar height parameters, particularly in the Koshino–Sugimoto (KS) index, which had the highest area under the curve (AUC: 0.87). Using genetic algorithms and logistic regression, our model excelled with seven key independent variables.

Conclusion

KS index and Wiberg index had the strongest association with lateral patellar dislocation. An optimized logistic regression model achieved an AUC of 0.934. Such performance is considered clinically relevant, indicating the model's effectiveness for the intended application.

Level of Evidence

Level Ⅲ.

Abstract Image

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应用机器学习和优化方法预测儿童和青少年髌骨不稳的风险因素。

目的：保守治疗仍是首次髌骨脱位的标准治疗方法。髌骨股骨不稳是一种常见的儿科损伤，其风险因素在成人中已得到充分证实，但有关儿科复发性髌骨脱位进展的数据仍然很少。我们开发了一种可重复的方法，利用磁共振成像（MRI）和机器学习分析对儿科患者的髌骨形态和解剖风险因素进行定量评估：对2005-2022年期间接受磁共振成像检查的被诊断为急性外侧髌骨脱位的儿科患者（54例）的回顾性研究数据进行分析，并与基于年龄的对照组（54例）进行比较。测量了髌股骨、胫骨、胫股骨和髌骨高度参数。分析了组间核磁共振成像参数的差异。通过机器学习和遗传算法分析评估了参数的潜在诊断效用：结果：两组患者在六项髌骨形态学参数上存在显著差异。在髌骨高度形态学参数方面，所有方法都显示出显著的组间差异。在胫骨和胫股骨形态参数中，只有胫骨结节-胫骨髁间距在两组间存在显著差异。没有性别差异。在髌骨高度参数中观察到了显著差异，尤其是越野-杉本（Koshino-Sugimoto，KS）指数，其曲线下面积（AUC：0.87）最高。利用遗传算法和逻辑回归，我们的模型在七个关键自变量中表现出色：结论：KS指数和Wiberg指数与髌骨外侧脱位的关系最为密切。优化后的逻辑回归模型的AUC达到了0.934。这样的表现被认为与临床相关，表明该模型在预期应用中是有效的：证据等级：Ⅲ级。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).