Hemiepiphysiodesis using 2-holed reconstruction plate for correction of angular deformity of the knee in children

Kurup, Jayakrishnan K. Narayana; Shah, Hitesh

doi:10.1016/j.jor.2020.01.001

Cited by 9 publications

(19 citation statements)

References 19 publications

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“…Deformity recurrence after implant removal, or the so-called rebound phenomenon, is a highly expected complication in the correction of the coronal plane deformities of the knee. 5 Although there is no uniform definition for this phenomenon, risk factors associated with deformity recurrence were studied in several publications [3][4][5]7,[13][14][15][16] proper methods to overcome this and their outcomes, however, were poorly investigated.…”

Section: Discussionmentioning

confidence: 99%

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The Fate of Overcorrection After Hemiepiphysiodesis in Valgus Deformities Around the Knee

Aksoy

Bakırcıoğlu

Özdemir

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Tension band plating is widely used in the surgical treatment of coronal plane deformities around the knee. The rebound phenomenon after implant removal is a common complication of this technique. Overcorrection of joint orientation angles is a method to minimize the effect of the rebound phenomenon. This study aims to investigate the natural course of overcorrected joint orientation angles after plate removal in patients with genu valgum deformity. Methods: Patients who underwent hemiepiphysiodesis with tension band plating due to genu valgum deformity between 2010 and 2019 were retrospectively analyzed. Mechanical lateral distal femoral angles (mLDFA) and mechanical medial proximal tibial angles were calculated before plate application, before implant removal, and at the last follow-up. At the implant removal, mLDFA>90 degrees and mechanical medial proximal tibial angles <85 degrees were accepted as overcorrected. Results: Seventy-two segments from 45 patients were included. For femoral valgus deformities (n=59), the mean mLDFAs at index surgery, implant removal, and the last follow-up were 79.8±3.9 degrees, 95.5±3.7 degrees, and 87.3±5.1 degrees, respectively. In the more and less than 10 degrees rebound groups, the median age of patients at index surgery were 66 and 101 months (P=0.04), the mLDFA during implant removal were 97.8 degrees and 94.4 degrees (P=0.005), and the mean amount of correction in mLDFA was 17 degrees and 13 degrees (P=0.001), respectively. At the last follow-up, joint orientation angles were found to be still overcorrected in 16 (22%), within normal limits in 36 (50%), and undercorrected in 20 (28%) segments. Ten (13%) segments required additional surgery due to residual deformity. Conclusions: Overcorrection with tension band plating is an effective modality in the treatment of genu valgum deformity. Rebound after plate removal increases as the age at index surgery decreases and the amount of conscious overcorrection increases. Most segments return to normal joint orientation angle limits after overcorrection. We recommend a mean of 5 degrees routine overcorrection in patients with genu valgum deformity to overcome the rebound phenomenon and to make future interventions easier if ever needed. Level of Evidence: Level III.

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Section: Discussionmentioning

confidence: 99%

“…Some studies mentioned overcorrection as a complication of poor patient follow-up. 16,21,22 To prevent misconceptions, it is imperative to state that we applied intentional overcorrection in the studied segments, and all follow-up visits were routinely carried out.…”

Section: Discussionmentioning

confidence: 99%

The Fate of Overcorrection After Hemiepiphysiodesis in Valgus Deformities Around the Knee

Aksoy

Bakırcıoğlu

Özdemir

et al. 2023

Journal of Pediatric Orthopaedics

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“…Pediatric lower limb deformities are a considerable problem for orthopedic surgeons [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. Genu valgum or varum may cause limping, pain, knee or patellar instability, gait disturbances, limited mobility, articular cartilage damage, accelerated joint degeneration, rapid fatigue, sports and physical activity limitations, meniscal injury, and cosmetic concerns [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Do Patient Sex and Age Affect Hemiepiphysiodesis Outcomes?

Morasiewicz,

Leyko,

Tomczyk

et al. 2024

JCM

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(1) Background: The purpose of this study was to assess the effects of sex and age on the outcomes of hemiepiphysiodesis performed for genu valgum and varum deformity correction. (2) Methods: We analyzed patients who had undergone O-Plate hemiepiphysiodesis due to genu valgum or varum in the period of 2020–2023. The study group comprised 22 females and 20 males aged between 3 and 14 years at the time of surgery. Age-stratification yielded a subgroup of 3–10-year-olds (16 patients, 20 treated limbs) and a subgroup of 11–14-year-olds (26 patients, 28 treated limbs). We assessed the following parameters: hospital stay duration, deformity correction time, MAD correction, amount of angular correction, correction velocity, correction rate, complete deformity correction, deformity recurrence, surgery duration, and complications. (3) Results: The mean follow-up was 19 months. The mean surgery time in the subgroup of 3–10-year-olds (25.62 min) was significantly longer than that in the subgroup of 11–14-year-olds (22.81 min, p = 0.018). The mean deformity correction time in the male subgroup (11.33 months) was significantly shorter than that in the female subgroup (15.87 months, p = 0.013). A comparison of the subgroups stratified by age yielded a mean amount of angular correction of 10.5° in the younger children, which was significantly higher than that of 7.2° achieved in the older children; p = 0.027. The difference in mean correction velocity between 3–10-year-old children (4.03 mm/month) and that in 11–14-year-old children (1.39 mm/month) was statistically significant; p = 0.031. The mean rate of correction was 0.49°/month in females and 0.89°/month in males, with the latter rate significantly greater; p = 0.023. The difference in the mean rate of correction between the younger (1.08°/month) and the older subgroup (0.59°/month) was also significant; p = 0.018. A significant difference in terms of deformity recurrence rates was observed between the younger subgroup (66.67%) and older subgroup (only 10.53%); p = 0.005. (4) Conclusions: Patient sex had no significant effect on hemiepiphysiodesis outcomes; patient age has a considerable effect on hemiepiphysiodesis outcomes.

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“…In countries where commercial guided growth plates are not available, two hole one-third tubular plates or reconstruction plates have been used as an alternative. 12 Although several studies have examined the biomechanics of tension band plates, no study to date has examined the biomechanics of different types of plate constructs. [13][14][15][16] The aim of this study was to compare the properties of four different plate constructs (two-hole guided-growth plates, four-hole guided-growth plates, locking guided-growth plates, and one-third tubular plates) using a three-point bending model.…”

Section: Introductionmentioning

confidence: 99%

“…The standard two-hole guided growth plate is most commonly used but other versions are commercially available including four-hole guided growth plates and two hole guided growth plates with locking screws. In countries where commercial guided growth plates are not available, two hole one-third tubular plates or reconstruction plates have been used as an alternative 12 . Although several studies have examined the biomechanics of tension band plates, no study to date has examined the biomechanics of different types of plate constructs 13–16 …”

Section: Introductionmentioning

confidence: 99%

The biomechanics of four guided growth plates

Wilson

Litsky

Iobst

2023

Current Orthopaedic Practice

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Background:Guided growth using the eight-plate is the most common method to correct angular deformities in children. We compared the properties of four plate constructs (two-hole guided-growth plates, four-hole guided-growth plates, locking guided-growth plates, and one-third tubular plates) using a three-point bending model. Methods:A three-point bending model was constructed to test strength of four plates. An osteotomy was made in a Sawbones Cylinder. The plate was then fixed across the osteotomy site using the appropriate screws designed for the plate. A 5 N preload was applied, and a linearly applied force was applied under displacement control. Constructs were loaded to failure. Results:For an angular correction of 8.5 degrees, the four-hole guidedgrowth plates required the most force (40.9 N) followed by twohole guided-growth plates (36.6 N). Locking plates and one-third tubular plates required less force to achieve the same correction (28.0 N and 23.0 N P < 0.001), respectively. The four-hole plate was the stiffest construct (1.87 N/mm). Load to failure for the fourhole plates (46.0 N), two-hole plates (42.8 N). locking plates (32.1 N), and one-third tubular plates (25.5 P < 0.001) followed similar trends as the force required for angular correction, with the four-hole plate requiring the most force. Conclusions:Despite the addition of two extra screws in the four-hole plate, this construct was only 10% stiffer than the two-hole plate. There is limited benefit to the use of a four-hole plate over a two-hole plate. The one-third tubular plate had the lowest load to failure of the four tested constructs.

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Hemiepiphysiodesis using 2-holed reconstruction plate for correction of angular deformity of the knee in children

Cited by 9 publications

References 19 publications

The Fate of Overcorrection After Hemiepiphysiodesis in Valgus Deformities Around the Knee

The Fate of Overcorrection After Hemiepiphysiodesis in Valgus Deformities Around the Knee

Do Patient Sex and Age Affect Hemiepiphysiodesis Outcomes?

The biomechanics of four guided growth plates

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