Efficacy and Safety of Percutaneous Epiphysiodesis Operation around the Knee to Reduce Adult Height in Extremely Tall Adolescent Girls and Boys

Abstract

Objective. The aim was to determine efficacy and safety of a surgical method to reduce adult height in extremely tall adolescents. Methods. Data for all girls (n = 12) and boys (n = 9) in our center subjected to bilateral percutaneous epiphysiodesis around the knee who had reached final height were included. Final height predictions were based on hand and wrist X-rays before surgery. Results. When compared to prediction, adult height was reduced by 4.1 ± 0.7 cm in treated girls (P < .001) and 6.4 ± 0.7 cm in treated boys (P < .001) corresponding to a 33.6 ± 3.4% and 33.6 ± 4.2% reduction of remaining growth, respectively. Besides mild to moderate postoperative pain reported in 9 operated individuals, no other side effects were reported. Postoperative X-rays confirmed growth plate closure and absence of leg angulations. Conclusions. Bilateral epiphysiodesis is an effective and safe method to reduce adult height in extremely tall girls and boys.

Risks of Malignant and Non-Malignant Tumours in Tall Women Treated with High-Dose Oestrogen during Adolescence

“…The use of high-dose oestrogen treatment in tall girls has decreased in the last two decades, most likely because of increased acceptance of tall stature in the society and worries about adverse effects [23]. Today, there is also another treatment option; bilateral percutaneous epiphysiodesis, a surgical approach that effectively reduces the remaining growth in tall adolescents [24]. …”

The Evaluation and Management of Tall Stature

“…As with hormonal treatment, the effect depends on the timing of the treatment. The remaining growth is reduced by approximately one third so that the surgery should generally be performed before bone age 12.5 years in girls and 14 years in boys and before a height of 170 cm in girls and 185 cm in boys to achieve a significant height reduction (at least 5 cm if predicted adult height is 185 cm in girls and 200 cm in boys) [14]. As leg growth is limited but growth of the back is not, this treatment alters body proportions.…”

“…As leg growth is limited but growth of the back is not, this treatment alters body proportions. However, since most tall individuals have relatively long legs, the sitting height/height ratio after treatment is closer to the population mean than before treatment [14,15]. Arms will also be relatively long, but this is generally not perceived as a problem.…”

“…Obviously, there is the (small) risk that is associated with any anaesthesia. In a series of 21 patients, one superficial cutaneous infection was reported that did not need treatment, and pain for up to 14 days occurred in 9 patients, which was treated with oral analgesics [14]. In another series of 15 patients, one developed exostosis at the fibula and two angular deformity, but none of these complications required intervention [15].…”

“…However, all patients should be closely followed after treatment in order to detect any such complications. Epiphysiodesis has also been performed in a few patients with Marfan syndrome without complications [14]. …”