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Relationships Among Severity of Osteonecrosis, Pain, Range of Motion, and Functional Mobility in Children, Adolescents, and Young Adults With Acute Lymphoblastic Leukemia

VG Marchese, PT, PhD, is a faculty member, Department of Physical Therapy, College of Allied Health Sciences, Health Science Center, University of Tennessee, Memphis, Tenn, and Department of Physical Therapy, Lebanon Valley College, 101 N College Ave, Annville, PA 17003 (USA)
BH Connolly, PT, DPT, EdD, FAPTA, is Chair, Department of Physical Therapy, College of Allied Health Sciences, Health Science Center, University of Tennessee
C Able, PT, is Staff Physical Therapist, Department of Physical Therapy, Momentum Physical Rehabilitation, Memphis, Tenn
AR Booten, PT, is Staff Physical Therapist, Baptist Hospital, Nashville, Tenn
P Bowen, PT, is Staff Physical Therapist, White County Community Hospital, Sparta, Tenn
BM Porter, PT, is Staff Physical Therapist, Henry County Medical Center, Paris, Tenn
SN Rai, PhD, is a faculty member, Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tenn
ML Hancock, MS, is a staff member, Department of Biostatistics, St Jude Children's Research Hospital
CH Pui, MD, is a faculty member, Division of Hematology-Oncology, St Jude Children's Research Hospital
S Howard, MD, is an assistant faculty member and Director of Clinical Trials, International Outreach Program, St Jude Children's Research Hospital, and Associate Professor, College of Medicine, Health Science Center, University of Tennessee
MD Neel, MD, is an assistant faculty member, Department of Surgery, Orthopedics, St Jude Children's Research Hospital
SC Kaste, DO, is a faculty member, Division of Diagnostic Imaging, St Jude Children's Research Hospital, and Department of Radiology, Health Science Center, University of Tennessee

Address all correspondence to Dr Marchese at: marchese{at}lvc.edu

Background and Purpose: Up to 38% of children receiving treatment for acute lymphoblastic leukemia (ALL) develop osteonecrosis, often without symptoms. Little is known about the association between the degree of osteonecrosis and functional mobility in this population. The purpose of this study was to examine relationships among the degree of osteonecrosis, pain, range of motion (ROM), and functional mobility in people with ALL.

Subjects: Thirty-three subjects aged 5 to 27 years with ALL and osteonecrosis participated.

Methods: The extent of osteonecrosis was determined by magnetic resonance imaging (MRI) of the hip and knee according to 2 classification systems, including the Association Research Circulation Osseous (ARCO) and a knee staging scale. Pain, hip and knee ROM, and the Timed Up and Down Stairs (TUDS) Test were used as measures.

Results: Correlations were observed between ARCO and hip pain (r=.34), between hip flexion ROM and hip pain (r=–.34), and between knee pain and time on the TUDS Test (r=–.35).

Discussion and Conclusion: Physical therapists should consider that people with ALL may have hip or knee osteonecrosis without clinical symptoms. This notion supports the need for MRI in addition to a comprehensive examination of functional mobility.