Rebound phenomenon and its risk factors after hemiepiphysiodesis using tension band plate in children with coronal angular deformity

Abstract

Background This study was performed to evaluate the rebound phenomenon after the correction of coronal angular deformity by hemiepiphysiodesis using tension band plate in children and to identify its risk factors. Methods We reviewed 50 children (mean age, 11.0 ± 2.5 years) with 94 physes who had undergone hemiepiphysiodesis using tension band plate due to coronal angular deformity of the lower limb. Patients’ demographic data including sex, age at initial surgery and plate removal, affected bone (distal femur or proximal tibia), affected side, and body mass index were collected. The mechanical lateral distal femoral angle (mLDFA) and the mechanical medial proximal tibial angle (mMPTA) were measured from the teleradiogram, Physes were divided into rebound and non-rebound group, and rebound group was defined as the physes which had ≥ 5° of mLDFA or mMPTA returning to its original deformity. Generalized estimating equation based multivariable analysis was used to identify the risk factors for the rebound phenomenon after the deformity correction. Results A total of 41 physes classified into rebound group and 53 physes into non-rebound group. There were significant differences in the age at initial surgery (p = 0.004), the age at implant removal (p = 0.002), the amount of correction (p = 0.001), and the rate of correction (p < 0.001) between two groups. The rate of correction was significantly associated with the rebound phenomenon (p = 0.044). The risk of rebound phenomenon was 1.2-fold higher as the rate of correction increased by 1° per year. The cutoff values of the correction rate between the two groups were 6.9°/year (p < 0.001). Conclusions This study showed that the rebound group had younger age and faster correction rate than those in the non-rebound group. In addition, the correction rate for deformity was a significant risk factor for the rebound phenomenon after hemiepiphysiodesis using the tension band plate. Close monitoring after implant removal is required for children who have a rapid correction rate over 7°/year.

Fusionless All-Pedicle Screws for Posterior Deformity Correction in AIS Immature Patients Permit the Restoration of Normal Vertebral Morphology and Removal of the Instrumentation Once Bone Maturity Is Reached

“…Removal of the instrumentation was conducted in all cases when patients reached Risser 5 pelvic maturity with complete fusion of the iliac process, to avoid the possibility of increasing residual scoliosis after the removal of the implant. The rationale of this was to avoid the rebound growth observed in other anatomical locations after the removal of guided growth implants [ 24 ]. This phenomenon can be prevented by maintaining the implants until bone maturation is complete [ 24 ].…”

“…The rationale of this was to avoid the rebound growth observed in other anatomical locations after the removal of guided growth implants [ 24 ]. This phenomenon can be prevented by maintaining the implants until bone maturation is complete [ 24 ].…”

Indications and Timing of Guided Growth Techniques for Pediatric Upper Extremity Deformities: A Literature Review

“…A high correction rate is a significant risk factor for developing overcorrection. This is found to be a direct indicator of physeal activity, wherein a higher rate of correction is indicative of a larger residual growth plate activity [52]. Younger age at initial surgery and implant removal may also pose a risk factor [53,54].…”

“…A rebound phenomenon after using tension band hemiepiphysiodesis is known to occur. This happens when the growth of the inhibited side of the physis exceeds that of the contralateral side due to transient overstimulation after tension band removal [52]. To compensate for this, a slight overcorrection can be aimed for.…”

Growth modulation for angular knee deformities: a practical guideline

“…The rebound is associated with rapid correction rates, younger children, more severe deformities (>20°), or in patients with at least 1 year of growth [5,77,78,79 ▪▪ ,80 ▪ –82 ▪ ]. A higher BMI may have a protective effect against a rebound [77].…”