Guided growth with tension band plate or definitive epiphysiodesis for treatment of limb length discrepancy?

Abstract

Background It is not exactly known whether guided growth or definitive epiphysiodesis techniques are superior in treating limb length discrepancy (LLD). The purpose of the present study was therefore to find out if definitive epiphysiodesis is associated with more powerful LLD correction than tension band plate epiphysiodesis. Methods Pediatric patients with LLD treated either with tension band plating as a guided growth technique (temporary epiphysiodesis) or a percutaneous drilling technique (definitive epiphysiodesis) around the knee and a minimum follow-up of 12 months were included in this retrospective study. Radiographic measurements were performed by two independent reviewers. The reduction in side difference between preoperative radiographs and last follow-up was calculated and compared between surgical techniques. Results Thirty-eight patients (mean age 13.6 years) were included, 17 treated with temporary and 21 with definitive epiphysiodesis. Average follow-up was at 578 days. The reduction of the LLD in 12 months was 5.7 mm in patients treated with temporary epiphysiodesis and 8.4 mm with definitive epiphysiodesis, respectively ( p = 0.22). In both groups, LLD could be statistically significantly reduced after 12 and 24 months. Definitive epiphysiodesis had a lower revision rate (4.8% vs. 17.6%). Intra- and interobserver reliability of the measurements was excellent. Conclusions As in earlier studies supposed, temporary epiphysiodesis with tension band plating seems to correct LLD less powerful compared to definitive percutaneous epiphysiodesis. However, in the present study, the differences of LLD correction were not statistically significant. We do not recommend the use of tension band plates for LLD correction due to inferior correction with higher complication and revision rate.

Tension-band Plating for Leg-length Discrepancy Correction

“…Previous studies showed that the rate of correction after temporary epiphysiodesis is slower than after surgical physeal ablation. 4 – 6 This is confirmed here, with a correction rate of 0.40 mm/month (4.8 mm/year) for proximal tibial and 0.68 mm/month (8.2 mm/year) for distal femoral temporary epiphysiodesis. This is slightly less than the average growth of 6 and 10 mm/year of the proximal tibia and distal femur, respectively, that could be expected without any intervention.…”

“…On the basis of this lower efficacy as compared to other methods, some authors have discarded the use of tension-band plates for length correction completely. 4 – 6 Nevertheless, the speed of inhibition of longitudinal growth by itself might not be the most important benefit with this technique; the timing of the procedure is considered too. As stated by Stevens, the goal is to produce growth deceleration and not growth arrest.…”

“…Dual tension-band plates are used as a means of temporary epiphysiodesis for longitudinal guided growth. 4 – 6 A growth modulating effect can be expected although the growth limiting effect is reported to be slower and less predictable as compared with definitive surgical physeal ablation. 4 , 6 , 7 When compared to other means of temporary epiphysiodesis (e.g.…”

“… 4 – 6 A growth modulating effect can be expected although the growth limiting effect is reported to be slower and less predictable as compared with definitive surgical physeal ablation. 4 , 6 , 7 When compared to other means of temporary epiphysiodesis (e.g. Blount staples), no difference in correction rate or residual LLD is reported.…”

Epiphysiodesis for the treatment of tall stature and leg length discrepancy

“…New implants for guided growth (i.e., tension band plating with the 8-plate) were initially intended for angular deformity correction; nevertheless attempts were made to correct LLD. Based on the current literature, the application of tension band plates for LLD reduction cannot be recommended due to the lower correction potential with higher complication and revision rates [44][45][46][47]. Other implants designed for temporary ED (i.e., RigidTack TM ) ( Fig.…”