The purpose was to investigate back pain and disability and their relationship to vertebral changes in patients with untreated Scheuermann's.

Overall, 136 patients who had attended the outpatient clinics between 1950 and 1990 for Scheuermann's were contacted, 49 of them (12 females, 37 males) responded. There was no difference in the baseline data between responders and non-responders. From radiographs, th-kyphosis, l-lordosis, and scoliosis were measured. The number of affected vertebrae and the degree of wedging were registered. Anthropometric data, occurrence of back pain, disability scores, and employment status were compared to a representative sample (n=3835) of the normal population.

After mean follow-up of 37 (6.5;25.9-53.7) y, their average age was 58.8 (8.2;44.4.-79.3) y. Male patients were significantly taller than the control subjects. Female patients were on average 6 kg heavier (P=0.016) and their mean BMI was higher (23.9 kg/m² vs 20.8 kg/m²,P=0.001) at age 20 than in the controls.

Females had a greater mean kyphosis than males (51.7 vs. 43.2°, p=0.11). There was no correlation between the degree of thoracic kyphosis and disability. Scheuermann's patients had an increased risk for constant back pain (P=0.003), a 2.6-fold risk for disability because of back pain during the past 5 years (P=0.002), a 3.7-fold risk for back pain during the past 30 days (P<0.001), and a 2.3-fold risk for sciatic pain (P=0.005). They reported a poorer quality of life (p<0.001) and general health (p<0.001). There was no difference in working ability and employment status between patients and controls.

Magnetic resonance imaging was used to analyse the patellofemoral relationships during the first 30 degrees of knee flexion in women with recurrent patellar dislocation. The patellofemoral joints were imaged both sagittally and axially with the knee flexed 0 degrees, 10 degrees, 20 degrees, and 30 degrees. At the beginning of knee flexion the sulcus angle was greater than in unaffected women, the lateral patellofemoral angle was smaller, the patella displaced further laterally, tilted more laterally and the congruence angle was directed more laterally. At 30 degrees of knee flexion these differences were less marked than at 0 degree to 10 degrees. Logistic regression analysis showed that the sulcus angle at 10 degrees of knee flexion was the most diagnostic feature, indicating that there is an anatomical predisposition to recurrent dislocation and that pathological patellar tracking starts from the beginning of flexion. Traditional sunrise radiographic films taken at 25 degrees to 30 degrees knee flexion clearly miss diagnostically important information.