Determining the Baseline Clinical Knee Measurements in the Multi-Ethnic Malaysian Children Aged 1-3 Years Old: A Population Study
Abstract
Introduction: Understanding knee alignment development in early childhood is essential to differentiate normal growth from pathology. However, local normative data are lacking. This study investigates knee development patterns in healthy Malaysian children aged three years and below.
Materials and methods: Three hundred healthy children were randomly selected from clinics, daycare centres, and screening programs in Klang Valley and equally divided into three age groups (0–12, 13–24, 25–36 months). Clinical assessments included intercondylar distance (ICD), tibiofemoral angle (TFA), mid-arm, and head circumference. One-way ANOVA, Kruskal-Wallis test, Pearson correlation, and multiple linear regression were used for analysis.
Results: Significant age-related changes were observed in ICD and TFA. Median ICD decreased from 5.00cm (0 – 12 months) to 1.00cm (13 – 24 months) and 0.00cm (25–36 months) (p<0.05). TFA shifted from varus (8.74°) to neutral (0.23°) and then to valgus (-4.91°) (p<0.05). No gender differences were found, but at 0 – 12 months, Malay children had greater varus angulation (9.55°) compared to Chinese (7.44°) and Indian (7.67°) children (p<0.05). ICD and TFA were negatively correlated with anthropometric measures (p<0.01). Multiple regression analysis revealed that ICD and height were independent predictors of TFA (p<0.001).
Conclusion: This study presents normative data on knee alignment in Malaysian children under three. Knee angulation progresses from varus in infancy to neutral by age two and valgus by age three. Clinicians can utilise population-specific normative data to track physiological bowing and identify cases requiring specialist referral when knee varus persists beyond the age of two.
Abstract | Reference
