Journal of Pediatric Orthopaedics - 2026-08-01 - Journal Article; Multicenter Study
Psychological Resilience in Children With Lower Limb Deformities: A Multicenter Quality of Life Study.
Griffiths AL, Narayanan UG, Iobst CA, Donnan LT
Topics
Key Takeaway
In 150 children with lower limb deformities, LLRS-AIM complexity correlated most strongly with sports/physical activity PODCI scores (r = -0.59), yet adolescent self-reported happiness was equivalent to general pediatric population norms despite significant functional deficits.
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Summary
This prospective cross-sectional multicenter study examined whether LLRS-AIM deformity complexity scores correlate with PODCI-measured health-related quality of life in children aged 5–18 with lower limb deformities across 3 international centers. Deformity complexity showed strong negative correlations with most PODCI domains, with the largest effect in sports/physical function (r = -0.59, P <0.01), and scores were significantly below published pediatric norms. Despite these functional deficits, adolescent self-reported happiness did not correlate with deformity complexity and was statistically similar to general population norms, indicating psychological resilience.
Key Limitation
Cross-sectional design captures a single time point and cannot determine whether observed adolescent happiness resilience persists through or after surgical reconstruction, which is the period of greatest psychological stress in this population.
Original Abstract
BACKGROUND
Children with lower-limb deformities encounter complex challenges impacting physical function and well-being. The Limb Lengthening and Reconstruction Society AIM (LLRS-AIM) index provides a standardized assessment of deformity complexity, but the relationship between complexity and quality of life remains poorly understood. This study aims to determine the strength of the relationship between lower limb deformity complexity and health-related quality of life in children and adolescents.
METHODS
We conducted a prospective cross-sectional study across 3 international centers over 2 years. Children aged 5 to 18 years with lower limb deformities completed the Pediatric Outcomes Data Collection Instrument (PODCI), while clinicians assessed deformity complexity using the The Limb Lengthening and Reconstruction Society AIM index. Correlations between deformity complexity and quality of life were analyzed, results were compared with published norms, and differences between parent and adolescent reports were examined.
RESULTS
Among 150 participants, deformity complexity showed strong negative correlations with global quality-of-life scores. The strongest relationships were observed in children with sports and physical activity function ( r =-0.59, P <0.01). Children and adolescents with lower-limb deformities scored significantly lower than the general pediatric population in most PODCI domains. Interestingly, deformity complexity did not correlate with adolescent self-reported happiness levels, and adolescent happiness was similar to that of the general pediatric population, suggesting resilience in psychological adaptation.
CONCLUSIONS
Children and adolescents with lower limb deformities experience significantly reduced quality of life, particularly concerning physical activities and sports participation. More complex deformities are linked to greater functional limitations and lower overall quality of life. While happiness in children with lower limb deformities is affected, adolescent happiness appears to be similar to that of the general pediatric population, which may indicate psychological adaptation and resilience.
LEVEL OF EVIDENCE
Level II-prospective cohort study.