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Mathematical modeling of the socalled Allis test: a field study in orthopedic confusion

BACKGROUND: Chiropractors use a variety of supine and prone leg checking procedures. Some, including the Allis test, purport to distinguish anatomic from functional leg length inequality. Although the reliability and to a lesser extent the validity of some leg checking procedures has been assessed,...

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Autores principales: Cooperstein, Robert, Haneline, Michael, Young, Morgan
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2007
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1796883/
https://www.ncbi.nlm.nih.gov/pubmed/17241470
http://dx.doi.org/10.1186/1746-1340-15-3
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author Cooperstein, Robert
Haneline, Michael
Young, Morgan
author_facet Cooperstein, Robert
Haneline, Michael
Young, Morgan
author_sort Cooperstein, Robert
collection PubMed
description BACKGROUND: Chiropractors use a variety of supine and prone leg checking procedures. Some, including the Allis test, purport to distinguish anatomic from functional leg length inequality. Although the reliability and to a lesser extent the validity of some leg checking procedures has been assessed, little is known on the Allis test. The present study mathematically models the test under a variety of hypothetical clinical conditions. In our search for historical and clinical information on the Allis test, nomenclatural and procedural issues became apparent. METHODS: The test is performed with the subject carefully positioned in the supine position, with the head, pelvis, and feet centered on the table. After an assessment for anatomic leg length inequality, the knees are flexed to approximately 90°. The examiner then sights the short leg side knee sequentially from both the foot and side of the table, noting its relative locations: both its height from the table and Y axis position. The traditional interpretation of the Allis test is that a low knee identifies a short tibia and a cephalad knee a short femur. Assuming arbitrary lengths and a tibio/femoral ratio of 1/1.26, and a hip to foot distance that placed the knee near 90°, we trigonometrically calculated changes in the location of the right knee that would result from hypothetical reductions in tibial and femoral length. We also modeled changes in the tibio/femoral ratio that did not change overall leg length, and also a change in hip location. RESULTS: The knee altitude diminishes with either femoral or tibial length reduction. The knee shifts cephalad when the femoral length is reduced, and caudally when the tibial length is reduced. Changes in the femur/tibia ratio also influence knee position, as does cephalad shifting of the hip. CONCLUSION: The original Allis (aka Galeazzi) test was developed to identify gross hip deformity in pediatric patients. The extension of this test to adults suspected of having anatomical leg length inequality is problematic, and needs refinement at the least. Our modeling questions whether this test can accurately identify aLLI, let alone distinguish a short tibia from a short femur.
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spelling pubmed-17968832007-02-10 Mathematical modeling of the socalled Allis test: a field study in orthopedic confusion Cooperstein, Robert Haneline, Michael Young, Morgan Chiropr Osteopat Research BACKGROUND: Chiropractors use a variety of supine and prone leg checking procedures. Some, including the Allis test, purport to distinguish anatomic from functional leg length inequality. Although the reliability and to a lesser extent the validity of some leg checking procedures has been assessed, little is known on the Allis test. The present study mathematically models the test under a variety of hypothetical clinical conditions. In our search for historical and clinical information on the Allis test, nomenclatural and procedural issues became apparent. METHODS: The test is performed with the subject carefully positioned in the supine position, with the head, pelvis, and feet centered on the table. After an assessment for anatomic leg length inequality, the knees are flexed to approximately 90°. The examiner then sights the short leg side knee sequentially from both the foot and side of the table, noting its relative locations: both its height from the table and Y axis position. The traditional interpretation of the Allis test is that a low knee identifies a short tibia and a cephalad knee a short femur. Assuming arbitrary lengths and a tibio/femoral ratio of 1/1.26, and a hip to foot distance that placed the knee near 90°, we trigonometrically calculated changes in the location of the right knee that would result from hypothetical reductions in tibial and femoral length. We also modeled changes in the tibio/femoral ratio that did not change overall leg length, and also a change in hip location. RESULTS: The knee altitude diminishes with either femoral or tibial length reduction. The knee shifts cephalad when the femoral length is reduced, and caudally when the tibial length is reduced. Changes in the femur/tibia ratio also influence knee position, as does cephalad shifting of the hip. CONCLUSION: The original Allis (aka Galeazzi) test was developed to identify gross hip deformity in pediatric patients. The extension of this test to adults suspected of having anatomical leg length inequality is problematic, and needs refinement at the least. Our modeling questions whether this test can accurately identify aLLI, let alone distinguish a short tibia from a short femur. BioMed Central 2007-01-22 /pmc/articles/PMC1796883/ /pubmed/17241470 http://dx.doi.org/10.1186/1746-1340-15-3 Text en Copyright © 2007 Cooperstein et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Cooperstein, Robert
Haneline, Michael
Young, Morgan
Mathematical modeling of the socalled Allis test: a field study in orthopedic confusion
title Mathematical modeling of the socalled Allis test: a field study in orthopedic confusion
title_full Mathematical modeling of the socalled Allis test: a field study in orthopedic confusion
title_fullStr Mathematical modeling of the socalled Allis test: a field study in orthopedic confusion
title_full_unstemmed Mathematical modeling of the socalled Allis test: a field study in orthopedic confusion
title_short Mathematical modeling of the socalled Allis test: a field study in orthopedic confusion
title_sort mathematical modeling of the socalled allis test: a field study in orthopedic confusion
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1796883/
https://www.ncbi.nlm.nih.gov/pubmed/17241470
http://dx.doi.org/10.1186/1746-1340-15-3
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