Long-term follow-up after bilateral percutaneous epiphysiodesis around the knee to reduce excessive predicted final height

Goedegebuure, Wesley J; Jonkers, Frank; Boot, Annemieke M.; Waarde, Willie M. Bakker-van; Tellingen, Vera van; Heeg, Minne; Odink, Roelof J.; Douveren, Florens van; Besselaar, A. T.; Steen, M. C. van der

doi:10.1136/archdischild-2017-313295

Cited by 16 publications

(12 citation statements)

References 32 publications

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“…Long-term complications were seen in 2.6% (axis deformity 1.3%, prominent head of fibula 1.3%). There was no significant difference in knee function between the two groups 20…”

Section: Commentmentioning

confidence: 71%

Pituitary gigantism: a rare learning opportunity

Bendor‐Samuel¹,

Pal

Cudlip

et al. 2019

Arch Dis Child Educ Pract Ed

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IntroductionPituitary gigantism is a rare but significant paediatric condition with complexities surrounding diagnosis and management. Transsphenoidal surgery (TSS) is the treatment of choice; however, medical treatment is often considered as adjuvant therapy.CaseA 10½ -year-old boy presented with tall stature and a height velocity of 11 cm/year. His height was 178.7 cm (+5.8 SD above mean) and insulin-like growth factor-1 (IGF-1) was elevated. An oral glucose tolerance test demonstrated non-suppression of growth hormone (GH). Initial contrast MRI was inconclusive, but C-11 methionine functional positron emission tomography CT identified a 6 mm pituitary microadenoma. A multidisciplinary team clinic held with the family allowed discussion about medical and surgical treatment options. Due to a number of factors including the patient’s young age, prepubertal status, a wish to allow him to settle into his new high school and his desire to reach a final height taller than his father’s height, it was decided to try medical therapy first with a somatostatin analogue. Pubertal induction was also commenced and bilateral epiphysiodesis surgery performed. Initial response to octreotide was positive; however, 4 months into therapy his IGF-1 was climbing and a repeat GH profile was not fully suppressed. The patient therefore proceeded to have successful TSS excision of the adenoma.ConclusionRare cases such as this require sharing of knowledge and expertise, so the best possible care is offered. It is often necessary to work across sites and disciplines. Each case requires an individual approach tailored to the patient and their family.

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“…Long-term complications were seen in 2.6% (axis deformity 1.3%, prominent head of fibula 1.3%). There was no significant difference in knee function between the two groups 20…”

Section: Commentmentioning

confidence: 71%

Pituitary gigantism: a rare learning opportunity

Bendor‐Samuel¹,

Pal

Cudlip

et al. 2019

Arch Dis Child Educ Pract Ed

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“…Short-term complications included wound infections in 4% of patients, and long term complications were seen in 2.6% including one valgus deformity and one prominent fibular head. Good knee function scores and a very high satisfaction rate of 97% could be observed [51] (Fig. 4).…”

Section: Evidence In Tall Staturementioning

confidence: 78%

Epiphysiodesis for the treatment of tall stature and leg length discrepancy

Willegger

Schreiner

Kolb

et al. 2021

Wien Med Wochenschr

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SummaryPainful orthopedic conditions associated with extreme tall stature and leg length discrepancy (LLD) include back pain and adopting bad posture. After failure of conservative treatment options, blocking of the growth plates (epiphysiodesis) around the knee emerged as gold standard in patients with tall stature and LLD in the growing skeleton. Surgical planning includes growth prediction and evaluation of bone age. Since growth prediction is associated with a certain potential error, adequate planning and timing of epiphysiodesis are the key for success of the treatment. LLD corrections up to 5 cm can be achieved, and predicted extreme tall stature can be limited. Percutaneous epiphysiodesis techniques are minimally invasive, safe and efficient methods with low complication rates. In general, a multidisciplinary approach should be pursued when treating children and adolescents with tall stature.

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“…The operation should be performed preferably at a bone age not exceeding 12.5 years in girls and 14 years in boys to achieve a significant height reduction. According to Goedegebuure et al , epiphysiodesis produces reductions of between 5 and 7 cm as seen in smaller studies [72-76]. (Figure 3 & Table 4 ).…”

Section: Treatment Of Tall Staturementioning

confidence: 91%

“…In the last years, it has been considered a surgical closure of the epiphyses, a great option especially in patients whose bone age is 12 years or above, when any medical intervention is unlikely to produce significant reductions in adult height [72]. Upners et al showed a 1.6 cm reduction in 18 of 26 girls treated with physiological doses of 17β-estradiol at the bone age above 12 years [65].…”

Section: Treatment Of Tall Staturementioning

confidence: 99%

Tall Stature: A Challenge for Clinicians

Corredor

Dattani

Gertosio

et al. 2019

CPR

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Clinicians generally use the term “tall stature” to define a height more than two standard deviations above the mean for age and sex. In most cases, these subjects present with familial tall stature or a constitutional advance of growth which is diagnosed by excluding the other conditions associated with overgrowth. Nevertheless, it is necessary to be able to identify situations in which tall stature or an accelerated growth rate indicate an underlying disorder. A careful physical evaluation allows the classification of tall patients into two groups: those with a normal appearance and those with an abnormal appearance including disproportion or dysmorphism. In the first case, the growth rate has to be evaluated and, if it is normal for age and sex, the subjects may be considered as having familial tall stature or constitutional advance of growth or they may be obese, while if the growth rate is increased, pubertal status and thyroid function should be evaluated. In turn, tall subjects having an abnormal appearance can be divided into proportionate and disproportionate syndromic patients. Before initiating further investigations, the clinician needs to perform both a careful physical examination and growth evaluation. To exclude pathological conditions, the cause of tall stature needs to be considered, although most children are healthy and generally do not require treatment to inhibit growth progression.In particular cases, familial tall stature subject can be treated by inducing puberty early and leading to a complete fusion of the epiphyses, so final height is reached. This review aims to provide proposals about the management of tall children.

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Long-term follow-up after bilateral percutaneous epiphysiodesis around the knee to reduce excessive predicted final height

Abstract: PE is safe and effective in children with predicted excessive AH. There was no difference in patient satisfaction between the PE and comparison group. Careful and detailed counselling is needed before embarking on treatment.

Cited by 16 publications

References 32 publications

Pituitary gigantism: a rare learning opportunity

Pituitary gigantism: a rare learning opportunity

Epiphysiodesis for the treatment of tall stature and leg length discrepancy

Tall Stature: A Challenge for Clinicians

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