A Predictive Score for Infantile Blount Disease Recurrence After Tibial Osteotomy

Abstract

Introduction and Objective: Several predictive factors for infantile Blount disease recurrence after tibial osteotomy were discovered. This study aimed to examine and utilize various predictors to develop a prediction score for infantile Blount disease recurrence after tibial osteotomy. Methods: We conducted a retrospective cohort study of infantile Blount disease patients who underwent tibial osteotomy between January 1998 and December 2020. Potential predictors, including clinical and radiographic parameters, were examined for their association with the disease recurrence after receiving tibial osteotomy. A predictive score was subsequently developed based on those potential predictors through multivariable logistic regression modeling. Results: A total of 101 extremities diagnosed with infantile Blount disease from 58 patients who underwent tibial osteotomy were included. Of those, 15 extremities (14.9%) recurred. Univariable logistic regression analysis identified age older than 42 months [odds ratio (OR)=4.28; P=0.026], Langenskiöld classification stage III (OR=9.70; P <0.001), LaMont classification type C (OR=15.44; P <0.001), preoperative femorotibial angle <−14 degrees (OR=4.21, P=0.021), preoperative metaphyseal-diaphyseal angle >16 degrees (OR=8.61, P=0.006), preoperative medial metaphyseal slope angle >70 degrees (OR=7.56, P=0.001), and preoperative medial metaphyseal beak angle >128.5 degrees (OR=13.46, P=0.001) as potential predictors of infantile Blount disease recurrence after tibial osteotomy. A predictive score comprised of age younger than 42 months, LaMont classification type C, and medial metaphyseal beak angle >128 degrees demonstrated an excellent predictive performance (area under the receiver operating characteristic curve =0.87), good calibration, and high internal validity. Conclusions: Our developed predictive score accurately predicted infantile Blount disease recurrence after tibial osteotomy. The results from our developed prediction tool allow physicians to inform prognosis, increase awareness during the follow-up period, and consider additional interventions to prevent disease recurrence. Level of Evidence: Level II

What’s New in Pediatric Orthopaedics

“…A predictive score was developed to accurately determine infantile Blount disease recurrence after tibial osteotomy and comprises age of <42 months, LaMont classification type C, and medial metaphyseal beak angle of >128° 19 . Another study of multiple types of coronal plane deformity evaluated the rate of correction for transphyseal screws and growth modulation plates from the time of the surgical procedure to the first postoperative radiograph.…”

Fatores de recorrência após intervenção na doença de Blount: uma revisão integrativa

“…7 , descrita da seguinte maneira por estes autores, em 3 estágios(tipos A, B e C): o tipo A defeito metafisário medial parcialmente transparente, tipo B apresenta curvatura descendente da borda lateral e inferior de um defeito metafisário completamente translúcido e o tipo C apresenta deformidade vertical descendente da epífise e Brazilian Journal of Health Review, Curitiba, v. 6, n. 5, p. 26364-26372, sep./oct., 2023 da metáfise. E como resultado desta mesma pesquisa os achados acerca deste sistema modificado foi que aquelas descritas pelo tipo C, traz um prognóstico ruim para correção bemsucedida por osteotomia tibial alta isoladamente ou em combinação com epifisiólise.…”

“…classificaram em seis níveis: sendo que para o nível respeito das osteotomias tibiais Santana et al,20226 destacam que, embora inicialmente utilizadas para correção de deformidades no plano coronal, simultaneamente ocorrem, alterações na inclinação posterior do planalto tibial e na altura patelar acarretando alterações biomecânicas do joelho e modificações na pressão de contato sobre a cartilagem, com consequências ainda incertas O estudo de Adulkasem et al, 20237 propôs um escore de predição para a recorrência de blount após osteotomia tibial, avaliando 58 pacientes que passaram pelo procedimento, do ponto de vista radiográfico, e identificando que pontuação preditiva composta por idade inferior a 42 meses, classificação de LaMont tipo C e ângulo do bico metafisário medial > 128 graus demonstrou um excelente desempenho preditivo.…”