A Radiographic Standard of Reference for the Growing Knee

By S. Idell Pyle, Ph.D., and Normand L. Hoerr, Ph.D., M.D. Cloth, $6.25. Pp. 135, with figures. Springfield, Ill., Thomas, 1969. This book is a modification of a previous work of the authors entitled Radiographic Atlas of Skeletal Development of the Knee. Most of the figures are unchanged, but the size of the book is increased from 82 to 135 pages. The increase is due chiefly to the printing of the knee films of the older children without minification as was done in the last edition and is actually a disadvantage since the anteroposterior and lateral views now occupy full pages facing each other, and one cannot read the text and the radiographs simultaneously. A welcome addition is the greater detail given to the neonatal knee. The textual material has been improved; in particular, the description of the maturational indicators is now clearer. Several of the plates have been changed significantly in order to agree with accepted maturational data. Ossification in the patella is now illustrated in a 48-month-old child, the standard time for its appearance. Similarly, ossification of the tibia tubercle is now shown in a 144-month-old male (Plate 22); it was not illustrated in the previous 12-year-old “standard”. The standards in this atlas were selected as the median knees in a group of children, Unfortunately, neither the previous nor the present edition describes the variation of some of these maturational factors in the normal population. Tables of means and standard deviations such as those in the Greu lich and Pyle Atlas of the Hand would have been most useful, and a similar set of tables in the knee book would be most welcome. The authors use a single standard for both males and females. This is not entirely accurate, owing to the sexual dimorphism in ossification sequence. Clinically, however, this probably is not significant. One minor change which this reviewer finds disadvantageous in clinical usage of the text is the marking of the ages in months rather than in years plus months as in the previous editions. For the practicing radiologist evaluation of skeletal maturation by comparison to an atlas such as this is the simplest and most efficient method, and the accuracy obtained is sufficient. The book is a useful reference that should be available to every practicing radiologist and it should be particularly useful in the evaluation of skeletal maturation in the younger infant in whom the hand standards are of limited value.