Guided growth vs.Tibial osteotomy at early stage of Blount disease in squelletically immature patients

Assan, Beaudelaire Romulus; Simon, Anne-Laure; Adjadohoun, Sonia; Segbedji, Géraud Garcia Ps.; Souchet, Philippe; Metchioungbe, Codjo Serge; Fiogbe, Michel Armand; Ilharreborde, Brice; Gbénou, Antoine Séraphin

doi:10.1016/j.jor.2021.05.006

Cited by 3 publications

(7 citation statements)

References 15 publications

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“…This issue may partially account for the disparity between the results obtained from the pooled analysis of all articles and the findings derived from the analysis of raw data alone, especially in terms of recurrence rates. However, our observations align with the results derived from the most extensive and well-conducted studies found in the literature, confirming the credibility of our findings [32,50,53,55,60,71,73,74].…”

Section: Limitationssupporting

confidence: 92%

“…Studies were conducted in centers in Africa (16 studies), Asia (7 studies), Europe (10 studies), and North America (28 studies). Patients from different continents were included in two case series (see details in Supplementary Materials, Table S1) [50,55]. Sex was reported for 975 patients (483 females, M/F ratio = 1.02/1).…”

Section: Demographics Clinical and Radiographic Characteristicsmentioning

confidence: 99%

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Recurrence and Complication Rates of Surgical Treatment for Blount’s Disease in Children: A Systematic Review and Meta-Analysis

Ramella,

Depaoli,

Menozzi

et al. 2023

JCM

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Background: Blount’s disease is a growth disorder of the proximal tibia that causes progressive genu varum in children. Surgical treatment is recommended if the deformity worsens, but which intervention is best remains controversial. This study aims to identify factors influencing outcomes and determine the most effective surgical approach. Methods: A systematic review was conducted of studies published before January 2022. Results: In total, 63 retrospective studies with CEBM IIIb/IV levels were included (1672 knees in 1234 patients). The most commonly reported treatment was acute correction via osteotomy (47%), followed by hemiepiphysiodesis (22%) and gradual correction (18%). Combined procedures were reported in 13% of cases. The overall recurrence rate was 18%, with a significant difference when comparing the recurrence rates after gradual correction with those after hemiepiphysiodesis (7% and 29%, respectively). Major complications beyond recurrence were observed in 5% of cases. A meta-analysis of the available raw data showed a significantly increased recurrence rate (39%) among treated children who were between 4.5 and 11.25 years of age and were followed for a minimum follow-up of 2.5 years. Conclusions: Overall, poor evidence with which to establish an optimal treatment for Blount’s disease was found. This study remarked on the need for early diagnosis, classification, and treatment of infantile tibia vara, since a significant rate of recurrence was found in neglected cases.

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Section: Limitationssupporting

confidence: 92%

Section: Demographics Clinical and Radiographic Characteristicsmentioning

confidence: 99%

Recurrence and Complication Rates of Surgical Treatment for Blount’s Disease in Children: A Systematic Review and Meta-Analysis

Ramella,

Depaoli,

Menozzi

et al. 2023

JCM

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“…Scott et al and Griswold et al reported age-based body mass index (BMI) percentile with an average of 93.76% between the two studies [ 12 , 13 ]. Together, the average BMI of included patients in Assan et al and Heflin et al was 20.8 [ 1 , 14 ]. Finally, Maré et al reported that two of the seven patients in their study had obesity [ 15 ].…”

Section: Reviewmentioning

confidence: 99%

Tension-Band Plating for Infantile Blount Disease: Efficacy and Outcomes Comprehensive Review

Raftis,

Helbing,

Dance

et al. 2024

Cureus

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“…Westburty et al concluded that the goals of hemi-epiphysiodesis in ITV and LOTV include (1) correction of deformity to avoid need for osteotomy, and (2) prevention of progression of the deformity to facilitate subsequent surgery [62]. Assan asserted that guided growth remains the best treatment for early ITV, and that the tibial osteotomy should be reserved for neglected forms or those close to skeletal maturity [63].…”

Section: Hemi-epiphysiodesismentioning

confidence: 99%

“…Andrade concluded that even though a discrete bony bridge cannot be demonstrated, there is significant enough growth disturbance of the medial physis in tibias with Langenskiöld III or greater, that unloading with valgus osteotomy will fail [65]. Although Rab had good short-term results with 15 months of follow-up, later studies showed a 60% recurrence rate with longer follow-up [63].…”

Section: Osteotomies With Acute Correctionmentioning

confidence: 99%

Deformity Reconstruction Surgery for Blount’s Disease

Robbins¹

2021

Children

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Blount’s disease is an idiopathic developmental abnormality affecting the medial proximal tibia physis resulting in a multi-planar deformity with pronounced tibia varus. A single cause is unknown, and it is currently thought to result from a multifactorial combination of hereditary, mechanical, and developmental factors. Relationships with vitamin D deficiency, early walking, and obesity have been documented. Regardless of the etiology, the clinical and radiographic findings are consistent within the two main groups. Early-onset Blount’s disease is often bilateral and affects children in the first few years of life. Late-onset Blount’s disease is often unilateral and can be sub-categorized as juvenile tibia vara (ages 4–10), and adolescent tibia vara (ages 11 and older). Early-onset Blount’s disease progresses to more severe deformities, including depression of the medial tibial plateau. Additional deformities in both groups include proximal tibial procurvatum, internal tibial torsion, and limb length discrepancy. Compensatory deformities in the distal femur and distal tibia may occur. When non-operative treatment fails the deformities progress through skeletal maturity and can result in pain, gait abnormalities, premature medial compartment knee arthritis, and limb length discrepancy. Surgical options depend on the patient’s age, weight, extent of physeal involvement, severity, and number of deformities. They include growth modulation procedures such as guided growth for gradual correction with hemi-epiphysiodesis and physeal closure to prevent recurrence and equalize limb lengths, physeal bar resection, physeal distraction, osteotomies with acute correction and stabilization, gradual correction with multi-planar dynamic external fixation, and various combinations of all modalities. The goals of surgery are to restore normal joint and limb alignment, equalize limb lengths at skeletal maturity, and prevent recurrence. The purpose of this literature review is to delineate basic concepts and reconstructive surgical treatment strategies for patients with Blount’s disease.

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Guided growth vs.Tibial osteotomy at early stage of Blount disease in squelletically immature patients

Cited by 3 publications

References 15 publications

Recurrence and Complication Rates of Surgical Treatment for Blount’s Disease in Children: A Systematic Review and Meta-Analysis

Recurrence and Complication Rates of Surgical Treatment for Blount’s Disease in Children: A Systematic Review and Meta-Analysis

Tension-Band Plating for Infantile Blount Disease: Efficacy and Outcomes Comprehensive Review

Deformity Reconstruction Surgery for Blount’s Disease

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