The Using of "Guided Growth" for Correction of Coronal Deformities around the Knee in Skeletally Immature Children (Systematic review and Metaanalysis)

Abstract

Introduction: Angular deformities of the lower limbs are common during childhood. The concept of guided growth using a tension band plate is a breakthrough in the surgical correction of angular deformities. This approach has yielded satisfactory results and has low complication rates. Patients and methods:We reviewed 210 papers with overall 433 patients and 809 deformities. Inclusion criteria included papers published from 2010 to 2017 in English literature. A Meta-analysis was done on 16 papers with seven outcomes: Change in mechanical axis deviation, Tibiofemoral angle, rate of excellent outcomes, implant breakage, implant migration, inadequate reduction and rebound phenomenon.Results: Thirty two studies were included. Fifteen of them studied treatment of angular deformities by guided growth, three of them discussed the complications of using guided growth and five studies discussed Biomechanics of using guided growth. Sixteen studies were included in our cumulative meta-analysis. Conclusion:Guided growth is effective in treating coronal deformities around the knee in skeletally immature children wither the cause was idiopathic or pathological. There is no limitation except if physeal bar is developed or the patient near maturity. Few complications are associated with guided growth techniques including rebound phenomenon, inadequate reduction, implant breakage and implant migration.

Rotational Guided Growth: A Preliminary Study of Its Use in Children

“…The total number of patients had open growth plates on preoperative radiographs. The underlying diagnoses included idiopathic femoral anteversion (3), internal tibial torsion (1), healed congenital pseudarthrosis of the tibia with NF-1 (1), and congenital femoral deficiency (1).…”

“…Hemiepiphysiodesis has evolved from the use of staples with perpendicular fixed legs to the use of a plate with pivoting screws [1]. The principle in both is to create a peripheral tether outside the physis, causing the physis to grow at its normal rate at the point farthest from the tether while limiting or temporarily stopping the growth at the point closest to the implant.…”

“…Traditionally, the only surgical technique available for treating rotational deformities of the femur or tibia was osteotomy, requiring open surgery, a period of non-weightbearing, and frequently, an inpatient hospital stay. The use of guided growth has been of great interest in the treatment of torsional deformities due to the decreased morbidity and limited recovery time that have been demonstrated in the treatment of frontal plane deformities [1]. A minimally invasive technique was recently reported as a method to correct torsional deformities in the femur in children [2] using a circumferential cable.…”

Physeal Migration During Knee-guided Growth With Tension Band Plates: Influence of Implant Position

“…Some previous studies mention physeal migration of the epiphyseal screw in guided growth as a complication of tension band plating, only two of which focus specifically on this complication; 15,16 the rest include screw migration together with other complications of guided growth with TBP. 4,14,18,19 One is a meta-analysis 20 and the other is a case report 13 (Table 4). Our results show a physeal migration rate of 5.91%; although higher than that of other studies, it is similar to the 5.88% rate reported by Heflin et al 18 and the 4% rate found by Ballal et al 4 and lower than the 7.7% reported by McClure et al 19 in knee flexion contractures, despite the fact that all these authors only describe one case each.…”