Correcting genu varum and genu valgum in children by guided growth

Ballal, Moez S.; Bruce, Collin; Nayagam, Selvadurai

doi:10.1302/0301-620x.92b2.22937

Cited by 145 publications

(140 citation statements)

References 22 publications

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“…The use of tension-band plating for guided growth has been the subject of several recent clinical papers (Stevens 2007, Burghardt et al 2008, Wiemann et al 2009, Burghardt and Herzenberg, 2010, Ballal et al 2010, Niethard et al 2010, Jelinek et al 2012). Faster correction was initially reported in 1 retrospective study when using tension-band plating compared to stapling (Stevens 2007).…”

Section: Discussionmentioning

confidence: 99%

Hemiepiphysiodesis: similar treatment time for tension-band plating and for stapling

Gottliebsen¹,

Rahbek²,

Hvid³

et al. 2013

Acta Orthopaedica

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Background In children with angulating deformities of the lower limbs, hemiepiphysiodesis can be used to guide growth to achieve better alignment at skeletal maturity. Traditionally, this has been performed with staples. The tension-band plating technique is new and it has been advocated because it is believed to reduce the risk of premature closure of the growth plate compared to stapling. The benefit of the tension-band plating technique has not yet been proven in experimental or randomized clinical studies.Methods We performed a randomized clinical trial in which 26 children with idiopathic genu valgum were allocated to stapling or tension-band plating hemiepiphysiodesis. Time to correction of the deformity was recorded and changes in angles on long standing radiographs were measured. Pain score using visual analog scale (VAS) was recorded for the first 72 h postoperatively. Analgesics taken were recorded by the parents.Results Mean treatment times for stapling hemiepiphysiodesis (n = 10) and for tension-band plating hemiepiphysiodesis (n = 10) were similar. Postoperative VAS scores and consumption of analgesics were also similar in both groups. No hardware failure or wound-related infection was observed.Interpreatation Treatment time for the 2 treatment modalities was not significantly different in this randomized clinical trial. Tension-band plating and stapling appeared to have a similar effect regarding correction of genu valgum. We cannot rule out type-II error and the possibility that our study was underpowered.ClinicalTrials.gov Identifier: NCT01641354.

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Section: Discussionmentioning

confidence: 99%

Hemiepiphysiodesis: similar treatment time for tension-band plating and for stapling

Gottliebsen¹,

Rahbek²,

Hvid³

et al. 2013

Acta Orthopaedica

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“…[1][2][3] Within the last decade, modular implants have been developed which consist of 2 screws (1 in the epiphysis and 1 in the metaphysis) and a spanning plate that captures each screw. [4][5][6][7][8][9][10][11][12] These have been promoted to be more efficient in their ability to correct deformity as they may retard less growth while still providing a peripheral tether that corrects angular deformity.…”

mentioning

confidence: 99%

Growth Retardation (Hemiepiphyseal Stapling) and Growth Acceleration (Periosteal Resection) as a Method to Improve Guided Growth in a Lamb Model

Noonan

Halanski

Leiferman

et al. 2016

Journal of Pediatric Orthopaedics

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“…Cases of excessive valgus can be corrected by guided growth procedures with minimal morbidity43 in older children with an intermalleolar distance of more than 8 cm. In a recurrent patellar dislocator with excessive genu valgum, correction of valgus alignment contributes to improved patella tracking and provide an extrinsic method of improving stability by effectively decreasing the TT-TG distance.…”

Section: Discussionmentioning

confidence: 99%

Patellofemoral joint alignment is a major risk factor for recurrent patellar dislocation in children and adolescents: a systematic review

et al. 2018

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ImportanceThe complex interplay of risk factors that predispose individuals to recurrent patellar dislocation is poorly understood, especially in paediatric patients who exhibit the most severe forms.ObjectiveThe primary aim of this study was to systematically review the current literature to characterise the lower limb alignment, patellofemoral morphology and soft tissue restraints of the patellofemoral joint (PFJ) through medical imaging measurements in paediatric recurrent patellar dislocators and age-matched control participants. The secondary aims were to synthesise the data to stratify the factors that influence PFJ stability and provide recommendations on the assessment and reporting of PFJ parameters in this patient population.Evidence reviewA systematic search was performed using CINAHL, the Cochrane Library, EMBASE, PubMed and Web of Science databases until June 2017. Two authors independently searched for studies that included typical children and adolescents who experienced patellar dislocation and also had direct measures of structural and dynamic risk factors. The methodological quality of the included studies was assessed through a customised version of the Downs and Black checklist. Weighted averages and SDs of measures that have been reported in more than one study were computed. A fixed-effects model was used to estimate the mean differences with 95% CIs regarding the association of recurrent patellar dislocation with patella alta, tibial tuberosity to trochlear groove (TT-TG) distance and bony sulcus angle.Findings20 of 718 articles met the inclusion criteria. Thirty-one risk factors were found; however, only 10 of these measurements had been assessed in multiple articles and only four had both dislocator and control population results. With respect to controls, patients with recurrent patellar dislocations had higher TT-TG distance (p<0.01) and higher bony sulcus angle (p<0.01).Conclusions and relevanceBased on the current scientific literature, increased TT-TG distances and bony sulcus angles predispose children and adolescents to recurrent patellar dislocation. Besides these measurements, studies reporting on recurrent patellar dislocation in children and adolescents should also include characterisation of lower limb alignment in coronal and axial planes and assessment of generalised ligamentous laxity.Level of evidenceSystematic review of prognostic studies, Levels II–IV.

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Correcting genu varum and genu valgum in children by guided growth

Cited by 145 publications

References 22 publications

Hemiepiphysiodesis: similar treatment time for tension-band plating and for stapling

Hemiepiphysiodesis: similar treatment time for tension-band plating and for stapling

Growth Retardation (Hemiepiphyseal Stapling) and Growth Acceleration (Periosteal Resection) as a Method to Improve Guided Growth in a Lamb Model

Patellofemoral joint alignment is a major risk factor for recurrent patellar dislocation in children and adolescents: a systematic review

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