A comparison of FELS and Tanner-Whitehouse II skeletal ages in male youth soccer players from the Middle East

Lolli, Lorenzo, Di Salvo, Valter, Monaco, Mauricio, Johnson, Amanda ORCID: https://orcid.org/0000-0002-1648-6506 and Gregson, Warren (2023) A comparison of FELS and Tanner-Whitehouse II skeletal ages in male youth soccer players from the Middle East. American Journal of Human Biology, 35 (10). e23941. ISSN 1042-0533

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Abstract

Objectives: To assess measurement agreement between FELS and Tanner-Whitehouse (TW) II skeletal ages in male youth soccer players from the Middle East. Methods: We examined agreement between FELS and TW-II skeletal ages using data collected between- and within-subjects (n = 1057 observations) for 409 male, full-time, academy student-athletes recruited as part of the Qatar Football Association national soccer development programme (chronological age range, 9.8 to 18 years; annual screening range, one to seven visits). The Bland–Altman method for repeated measurements estimated the limits of agreement describing the expected range of differences for 95% of pairs of future FELS and TW-II skeletal ages determined on similar individuals from the reference population. Results: The mean difference for TW-II versus FELS protocols was 0.02 years (95% confidence interval, −0.04 to 0.08 years) with lower and upper limits of agreement ranging from −1.39 years (95% confidence interval, −1.48 to −1.30 years) to 1.43 years (95% confidence interval, 1.34 to 1.52 years). Conclusion: Differences for 95% of pairs of future skeletal ages determined with FELS and TW-II methods in this population could be as high as ~3 years for some people that suggested protocols may not be interchangeable in youth Middle Eastern athletes. Justification of skeletal age protocol selection rests on knowledge of measurement bias and variability of expected growth estimations for rationalized application to a population of interest.