Growth modulation for angular knee deformities: a practical guideline

Abstract

Purpose of reviewThis study aimed to review the established concepts and advances related to growth modulation for treating knee angular deformities. Although they are considered well tolerated procedures, careful indications and accurate techniques are necessary to ensure good results.Recent findingsIn addition to general clinical and radiographic evaluations, new tools such as two-dimensional low-dose radiography and gait analysis have been used to clarify angular and torsional combinations and the impact of mild angulations on the knee joint. Temporary epiphysiodesis is commonly the choice, and it can be performed with different implants such as staples, tension band plates (TBP), percutaneous transphyseal screws (PETS), sutures, and screws.SummaryConsidering its principles, TBP has been preferred for younger children. Cost can be a limitation, and research for alternative implants such as screws and nonabsorbable sutures indicate they might be an alternative in the future. In adolescents, PETS becomes an attractive alternative; however, its reversible character has been controversial, and further studies are needed to establish limits in younger patients.

Guided Growth Technique for Epiphysiodesis and Hemiepiphysiodesis: Safety and Performance Evaluation

“…Paediatric orthopaedists state that lower-limb angular deformities are one of the most frequently non-traumatic conditions being researched [1][2][3]. While lower limb position tends to change during growth, from slight varus to slight valgus between 1 and 7 years of age, past this threshold, a paediatric subject is considered to have a neutral alignment [3][4][5]. When this is not the case, lower-limb deformities may compromise gait, produce pain, give instability, and limit functionality [3,4].…”

“…While lower limb position tends to change during growth, from slight varus to slight valgus between 1 and 7 years of age, past this threshold, a paediatric subject is considered to have a neutral alignment [3][4][5]. When this is not the case, lower-limb deformities may compromise gait, produce pain, give instability, and limit functionality [3,4]. Lower-limb deformities may include both idiopathic and pathological malalignment and limb-length discrepancies.…”

“…Guided growth or modulation of the growing bone is widely approved as the first-line approach when conservative treatment has failed [4,6]. This is mainly because it is simple to technically assimilate and perform, is minimally invasive and reversible, gives rise to lesser evident scars, and has fewer complications compared to other more invasive treatments such as osteotomy with acute correction and stabilization, physeal bar resection, or multi-planar dynamic external fixation [3,4,6].…”

“…Although these procedures are deemed to be safe and effective, proper indication and meticulous application of the standard technique are essential to good outcomes [4]. Timely intervention is paramount for a successful outcome, as late indication may lead to incomplete corrections [3,4,7]. The treatment aims to restore limb alignment, arrest progression, and prevent recurrence after the intervention [6,8].…”

Simultaneous MPFL reconstruction and guided growth result in low rates of recurrent patellofemoral instability

“…Among children with open physes, implantmediated guided growth (IMGG) utilising tension plates has become a popular method of treating these deformities while preserving future growth potential [4,22,24,30,32,34]. The extra-periosteal tension band plate acts as a focal hinge at the perimeter of the physis, leading to compression and stunted growth on the implant side and normal, corrective growth on the noncompressed edge of the physis [2,41].…”