Review Question - QID 219572

Peak growth velocity occurs before Risser stage 1 and is the best predictor of curve progression in adolescent idiopathic scoliosis (AIS; Answer 3).

The point at which an adolescent undergoes the fastest growth rate is referred to as peak growth velocity. It occurs one and a half to two years earlier in females, typically just before menarche and before Risser stage 1. Peak growth velocity is a reliable predictor of curve progression in AIS and sports injury risk.

Johnson et al. assessed 180 skeletally immature patients (using Sanders staging classification) with AIS and a primary curve less than 25 degrees to identify predictors of curve progression. They identified high-risk patient groups as those at Sanders 1-2 growth staging with a curve greater than 10 degrees and Sanders 3-6 with a curve greater than 20 degrees. The high-risk patients had a risk greater than five times that of the low-risk groups in progressing to a bracing range for their curves. They concluded that curve magnitude and skeletal maturity may be used to predict curve progression beyond 25 degrees and the requirement of formal bracing in AIS patients.

Kleanthous et al. performed a mixed-longitudinal study to assess height velocity and growth milestones among a cohort of Greek schoolchildren. They found that a height take-off period occurs in males and females one to one and a half years before physical signs of puberty. Peak height velocity was reached in males at an average age of 12.61 years and in females at 10.93 years. They also discussed that increased levels of insulin-like growth factor-1 (IGF-1) and estradiol prime children for the onset of puberty, while testosterone does not seem to play a direct role in the onset of pubertal growth. The authors concluded that the adolescent growth spurt is likely triggered by a gradual increase in estradiol and IGF-1, which occurs earlier in females than males.

Dupre and Potthast performed a kinematic analysis of 22 male adolescent patients to assess the etiology and risk of groin injuries in pubertal soccer players. They compared a group of 12 patients estimated to be more than half a year before peak growth velocity (PRE group) to a second group who were estimated to be less than half a year before or after peak growth velocity (MID group). They found that the MID group was significantly taller and heavier than the PRE group, hip joint force measurements were similar between the groups, and the MID group had a higher hip abduction moment during cutting maneuvers. The authors concluded that the study participant’s extremity moments of inertia increase faster than their muscles can adapt, the higher hip abduction moment seen in the MID group likely increases the load on the adductor muscles, and combined, these two observations likely confer an increased risk of groin injuries during peak growth velocity.

Incorrect Answers:
Answer 1: Peak growth velocity typically occurs just before menarche in females
Answer 2: Females reach peak growth velocity before males
Answer 4: Peak growth velocity occurs before Risser Stage 1
Answer 5: Estradiol and IGF-1 are closely associated with the onset of pubertal growth