Guided Growth in Lower Extremities
Journal: Advances in Medicine and Engineering Interdisciplinary Research DOI: 10.32629/ameir.v2i3.2598
Abstract
Guided growth is a surgical option of increasing use for the correction of angular deformities of the lower extremities in skeletally immature patients. It is possible to perform in multiple planes or segments, with excellent results. Its most frequent use is in deformities of the coronal plane around the knee. Permanent epiphysiodesis can be performed in patients within 2 years before the end of longitudinal growth of the segment to be treated, considering temporary epiphysiodesis for patients with more than 2 years of remaining growth. In mild to moderate cases, the success rates reach even 100% in some series, while patients with Blount's disease, obesity, advanced skeletal age or severe deformities are less likely to achieve a complete correction. Regardless of the surgical technique, adequate preoperative planning, family education and strict follow-up are necessary to minimize complications and allow excellent correction of the deformity with minimal morbidity.
Keywords
growth plate; genu valgum; genu varum; lower extremities
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[1]Stevens PM. 2007. Guided growth for angular correction: a preliminary series using a tension band plate. J Pediatr Orthop. 27(3):253-9. doi: 10.1097/BPO.0b013e31803433a1
[2]Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD. 2001. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA. 286(2):188-95. doi: 10.1001/jama.286.2.188
[3]Hefti F, Hasler C. 2007. Chapter 4.2: Axes and Lengths. In Hefti F, ed. Pediatric Orthopedic in Practice. Berlín Heidelberg: Springer; 2007:547-556. doi: 10.1007/978-3-540-69964-4
[4]Peterson HA.2007. Chapter 2: Anatomy and growth. In Peterson HA, ed. Epiphyseal Growth Plate Fractures. Berlin Heidelberg: Springer; 2007:7-19. doi: 10.1007/978-3-540-33802-4
[5]Kronenberg HM. 2003. Developmental regulation of the growth plate. Nature. 423(6937):332-6. doi: 10.1038/nature01657
[6]Gottliebsen M, Shiguetomi-Medina JM, Rahbek O, Møller-Madsen B. 2016. Guided growth: mechanism and reversibility of modulation. J Child Orthop. 10(6):471-477. doi: 10.1007/s11832-016-0778-9
[7]Ross TK, Zionts LE. 1997. Comparison of different methods used to inhibit physeal growth in a rabbit model. Clin Orthop Relat Res. 340:236-43. doi: 10.1097/00003086-199707000-00031
[8]Phemister DB. 1933. Operative arrestment of longitudinal growth of bones in the treatment of deformities. J Bone Joint Surg Am. 15(1):1-15.
[9]Bowen JR, Johnson WJ. 1984. Percutaneous epiphysiodesis. Clin Orthop Relat Res. 190:170-173.
[10]Blount WP, Clarke GR. 1949. Control of bone growth by epiphyseal stapling; a preliminary report. J Bone Joint Surg Am. 31A(3):464-478.
[11]Blount WP. 1971. A mature look at epiphyseal stapling. Clin Orthop Relat Res. 77:158-163.
[12]Métaizeau JP, Wong-Chung J, Bertrand H, Pasquier P. 1998. Percutaneous epiphysiodesis using transphyseal screws (PETS). J Pediatr Orthop. 18(3):363-369.
[13]Martínez G, Gündel A, Ruiz P, Cañete I, Hodgson F. 2019. Distal femoral hemiepiphysiodesis with screws and suture versus 8-plate for the treatment of genu valgum in children. Orthop Traumatol Surg Res. 105(4):751-755. doi: 10.1016/j.otsr.2019.02.019
[14]Kumar S, Sonanis SV. 2018. Growth modulation for coronal deformity correction by using Eight Plates-Systematic review. J Orthop. 15(1):168-172. doi: 10.1016/j.jor.2018.01.022
[15]Yeo A, James K, Ramachandran M. 2015. Normal lower limb variants in children. BMJ. 350:h3394. doi: 10.1136/bmj.h3394
[16]Standard SC. 2014. Chapter 1: Normal Limb Alignment. In: Standard SC, Herzenberg JE, Conway JD, Lamm BM, Siddiqui NA. The Art of Limb Alignment, 3rd Edition. Baltimore: International Center for Limb Lengthening; 2014:1-15.
[17]Paley D. 2003. Chapter 4: Frontal Plane Mechanic and Anatomic Axis Planning. In: Paley D. Principles of deformity correction. Berlin, Heidelberg, New York: Springer; 2003:61-97.
[18]Paley D. 2003. Chapter 6: Sagital Plane Deformities. In: Paley D. Principles of deformity correction. Berlin, Heidelberg, New York: Springer; 2003:155-174.
[19]Gupta P, Gupta V, Patil B, Verma V. 2020. Angular deformities of lower limb in children: Correction for whom, when and how? J Clin Orthop Trauma. 11(2):196-201. doi: 10.1016/j.jcot.2020.01.008
[20]Stevens PM. 2016. The role of guided growth as it relates to limb lengthening. J Child Orthop. 10(6):479-486. doi: 10.1007/s11832-016-0779-8
[21]Makarov MR, Jackson TJ, Smith CM, Jo CH, Birch JG. 2018. Timing of epiphysiodesis to correct leg-length discrepancy: a comparison of prediction methods. J Bone Joint Surg Am. 100(14):1217-1222. doi: 10.2106/JBJS.17.01380
[22]Canale ST, Russell TA, Holcomb RL. 1986. Percutaneous epiphysiodesis: experimental study and preliminary clinical results. J Pediatr Orthop. 6(2):150-6.
[23]Bayhan IA, Karatas AF, Rogers KJ, Bowen JR, Thacker MM. 2017. Comparing percutaneous physeal epiphysiodesis and eight-plate epiphysiodesis for the treatment of limb length discrepancy. J Pediatr Orthop. 37(5):323-327. doi: 10.1097/BPO.0000000000000647
[24]Borbas P, Agten CA, Rosskopf AB, Hingsammer A, Eid K, Ramseier LE.2019. Guided growth with tension band plate or definitive epiphysiodesis for treatment of limb length discrepancy? J Orthop Surg Res. 14(1):99. doi: 10.1186/s13018-019-1139-4.
[25]Stevens PM. 2018. Invalid comparison between methods of epiphysiodesis. J Pediatr Orthop. 38(1):e29-e30. doi: 10.1097/BPO.0000000000001020
[26]Portinaro N, Turati M, Cometto M, Bigoni M, Davids JR, Panou A. 2019. Guided growth of the proximal femur for the management of hip dysplasia in children with cerebral palsy. J Pediatr Orthop. 39(8):e622-e628. doi: 10.1097/BPO.0000000000001069
[27]Hsieh HC, Wang TM, Kuo KN, Huang SC, Wu KW. 2019. Guided growth improves coxa valga and hip subluxation in children with cerebral palsy. Clin Orthop Relat Res. 477(11):2568-2576. doi: 10.1097/CORR.0000000000000903
[28]Shabtai L, Herzenberg JE. 2016. Limits of Growth Modulation Using Tension Band Plates in the Lower Extremities. J Am Acad Orthop Surg. 24(10):691-701. doi: 10.5435/JAAOS-D-14-00234
[29]Holder J, Feja Z, van Drongelen S, Adolf S, Böhm H, Meurer A, et al. 2020. Effect of guided growth intervention on static leg alignment and dynamic knee contact forces during gait. Gait Posture. 78:80-88. doi: 10.1016/j.gaitpost.2020.03.012
[30]Ballal MS, Bruce CE, Nayagam S. 2010. Correcting genu varum and genu valgum in children by guided growth: temporary hemiepiphysiodesis using tension band plates. J Bone Joint Surg Br. 92(2):273-6. doi: 10.1302/0301-620X.92B2.22937
[31]Aslani H, Panjavy B, Bashy RH, Tabrizi A, Nazari B. 2014. The efficacy and complications of 2-hole 3.5 mm reconstruction plates and 4 mm noncanulated cancellous screws for temporary hemiepiphysiodesis around the knee. J Pediatr Orthop. 34(4):462-6. doi: 10.1097/BPO.0000000000000115
[32]Klatt J, Stevens PM. 2008. Guided growth for fixed knee flexion deformity. J Pediatr Orthop. 28(6):626-31. doi: 10.1097/BPO.0b013e318183d573
[33]Macwilliams BA, Harjinder B, Stevens PM. 2011. Guided growth for correction of knee flexion deformity: a series of four cases. Strategies Trauma Limb Reconstr. 6(2):83-90. doi: 10.1007/s11751-011-0110-7
[34]Kramer A, Stevens PM. 2001. Anterior femoral stapling. J Pediatr Orthop. 21(6):804-807.
[35]Stiel N, Babin K, Vettorazzi E, Breyer S, Ebert N, Rupprecht M, Stuecker R, Spiro AS. 2018. Anterior distal femoral hemiepiphysiodesis can reduce fixed flexion deformity of the knee: a retrospective study of 83 knees. Acta Orthop. 89(5):555-559. doi: 10.1080/17453674.2018.1485418
[36]Al-Aubaidi Z, Lundgaard B, Pedersen NW. 2012. Anterior distal femoral hemiepiphysiodesis in the treatment of fixed knee flexion contracture in neuromuscular patients. J Child Orthop. 6(4):313-8. doi: 10.1007/s11832-012-0415-1
[37]Lesiak AC, Esposito PW. 2014. Progressive valgus angulation of the ankle secondary to loss of fibular congruity treated with medial tibial hemiepiphysiodesis and fibular reconstruction. Am J Orthop (Belle Mead NJ). 43(6):280-3.
[38]Noonan KJ, Feinberg JR, Levenda A, Snead J, Wurtz LD. 2002. Natural history of multiple hereditary osteochondromatosis of the lower extremity and ankle. J Pediatr Orthop. 22(1):120-4.
[39]Driscoll MD, Linton J, Sullivan E, Scott A. 2014. Medial malleolar screw versus tension-band plate hemiepiphysiodesis for ankle valgus in the skeletally immature. J Pediatr Orthop. 34(4):441-6. doi: 10.1097/BPO.0000000000000116
[40]Inan M, Chan G, Littleton AG, Kubiak P, Bowen JR. 2008. Efficacy and safety of percutaneous epiphysiodesis. J Pediatr Orthop. 28(6):648-51. doi: 10.1097/BPO.0b013e3181832475
[41]Saran N, Rathjen KE. 2010. Guided growth for the correction of pediatric lower limb angular deformity. J Am Acad Orthop Surg. 18(9):528-36. doi: 10.5435/00124635-201009000-00004
[42]Schroerlucke S, Bertrand S, Clapp J, Bundy J, Gregg FO. 2009. Failure of Orthofix eight-Plate for the treatment of Blount disease. J Pediatr Orthop. 29(1):57-60. doi: 10.1097/BPO.0b013e3181919b5
[2]Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD. 2001. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA. 286(2):188-95. doi: 10.1001/jama.286.2.188
[3]Hefti F, Hasler C. 2007. Chapter 4.2: Axes and Lengths. In Hefti F, ed. Pediatric Orthopedic in Practice. Berlín Heidelberg: Springer; 2007:547-556. doi: 10.1007/978-3-540-69964-4
[4]Peterson HA.2007. Chapter 2: Anatomy and growth. In Peterson HA, ed. Epiphyseal Growth Plate Fractures. Berlin Heidelberg: Springer; 2007:7-19. doi: 10.1007/978-3-540-33802-4
[5]Kronenberg HM. 2003. Developmental regulation of the growth plate. Nature. 423(6937):332-6. doi: 10.1038/nature01657
[6]Gottliebsen M, Shiguetomi-Medina JM, Rahbek O, Møller-Madsen B. 2016. Guided growth: mechanism and reversibility of modulation. J Child Orthop. 10(6):471-477. doi: 10.1007/s11832-016-0778-9
[7]Ross TK, Zionts LE. 1997. Comparison of different methods used to inhibit physeal growth in a rabbit model. Clin Orthop Relat Res. 340:236-43. doi: 10.1097/00003086-199707000-00031
[8]Phemister DB. 1933. Operative arrestment of longitudinal growth of bones in the treatment of deformities. J Bone Joint Surg Am. 15(1):1-15.
[9]Bowen JR, Johnson WJ. 1984. Percutaneous epiphysiodesis. Clin Orthop Relat Res. 190:170-173.
[10]Blount WP, Clarke GR. 1949. Control of bone growth by epiphyseal stapling; a preliminary report. J Bone Joint Surg Am. 31A(3):464-478.
[11]Blount WP. 1971. A mature look at epiphyseal stapling. Clin Orthop Relat Res. 77:158-163.
[12]Métaizeau JP, Wong-Chung J, Bertrand H, Pasquier P. 1998. Percutaneous epiphysiodesis using transphyseal screws (PETS). J Pediatr Orthop. 18(3):363-369.
[13]Martínez G, Gündel A, Ruiz P, Cañete I, Hodgson F. 2019. Distal femoral hemiepiphysiodesis with screws and suture versus 8-plate for the treatment of genu valgum in children. Orthop Traumatol Surg Res. 105(4):751-755. doi: 10.1016/j.otsr.2019.02.019
[14]Kumar S, Sonanis SV. 2018. Growth modulation for coronal deformity correction by using Eight Plates-Systematic review. J Orthop. 15(1):168-172. doi: 10.1016/j.jor.2018.01.022
[15]Yeo A, James K, Ramachandran M. 2015. Normal lower limb variants in children. BMJ. 350:h3394. doi: 10.1136/bmj.h3394
[16]Standard SC. 2014. Chapter 1: Normal Limb Alignment. In: Standard SC, Herzenberg JE, Conway JD, Lamm BM, Siddiqui NA. The Art of Limb Alignment, 3rd Edition. Baltimore: International Center for Limb Lengthening; 2014:1-15.
[17]Paley D. 2003. Chapter 4: Frontal Plane Mechanic and Anatomic Axis Planning. In: Paley D. Principles of deformity correction. Berlin, Heidelberg, New York: Springer; 2003:61-97.
[18]Paley D. 2003. Chapter 6: Sagital Plane Deformities. In: Paley D. Principles of deformity correction. Berlin, Heidelberg, New York: Springer; 2003:155-174.
[19]Gupta P, Gupta V, Patil B, Verma V. 2020. Angular deformities of lower limb in children: Correction for whom, when and how? J Clin Orthop Trauma. 11(2):196-201. doi: 10.1016/j.jcot.2020.01.008
[20]Stevens PM. 2016. The role of guided growth as it relates to limb lengthening. J Child Orthop. 10(6):479-486. doi: 10.1007/s11832-016-0779-8
[21]Makarov MR, Jackson TJ, Smith CM, Jo CH, Birch JG. 2018. Timing of epiphysiodesis to correct leg-length discrepancy: a comparison of prediction methods. J Bone Joint Surg Am. 100(14):1217-1222. doi: 10.2106/JBJS.17.01380
[22]Canale ST, Russell TA, Holcomb RL. 1986. Percutaneous epiphysiodesis: experimental study and preliminary clinical results. J Pediatr Orthop. 6(2):150-6.
[23]Bayhan IA, Karatas AF, Rogers KJ, Bowen JR, Thacker MM. 2017. Comparing percutaneous physeal epiphysiodesis and eight-plate epiphysiodesis for the treatment of limb length discrepancy. J Pediatr Orthop. 37(5):323-327. doi: 10.1097/BPO.0000000000000647
[24]Borbas P, Agten CA, Rosskopf AB, Hingsammer A, Eid K, Ramseier LE.2019. Guided growth with tension band plate or definitive epiphysiodesis for treatment of limb length discrepancy? J Orthop Surg Res. 14(1):99. doi: 10.1186/s13018-019-1139-4.
[25]Stevens PM. 2018. Invalid comparison between methods of epiphysiodesis. J Pediatr Orthop. 38(1):e29-e30. doi: 10.1097/BPO.0000000000001020
[26]Portinaro N, Turati M, Cometto M, Bigoni M, Davids JR, Panou A. 2019. Guided growth of the proximal femur for the management of hip dysplasia in children with cerebral palsy. J Pediatr Orthop. 39(8):e622-e628. doi: 10.1097/BPO.0000000000001069
[27]Hsieh HC, Wang TM, Kuo KN, Huang SC, Wu KW. 2019. Guided growth improves coxa valga and hip subluxation in children with cerebral palsy. Clin Orthop Relat Res. 477(11):2568-2576. doi: 10.1097/CORR.0000000000000903
[28]Shabtai L, Herzenberg JE. 2016. Limits of Growth Modulation Using Tension Band Plates in the Lower Extremities. J Am Acad Orthop Surg. 24(10):691-701. doi: 10.5435/JAAOS-D-14-00234
[29]Holder J, Feja Z, van Drongelen S, Adolf S, Böhm H, Meurer A, et al. 2020. Effect of guided growth intervention on static leg alignment and dynamic knee contact forces during gait. Gait Posture. 78:80-88. doi: 10.1016/j.gaitpost.2020.03.012
[30]Ballal MS, Bruce CE, Nayagam S. 2010. Correcting genu varum and genu valgum in children by guided growth: temporary hemiepiphysiodesis using tension band plates. J Bone Joint Surg Br. 92(2):273-6. doi: 10.1302/0301-620X.92B2.22937
[31]Aslani H, Panjavy B, Bashy RH, Tabrizi A, Nazari B. 2014. The efficacy and complications of 2-hole 3.5 mm reconstruction plates and 4 mm noncanulated cancellous screws for temporary hemiepiphysiodesis around the knee. J Pediatr Orthop. 34(4):462-6. doi: 10.1097/BPO.0000000000000115
[32]Klatt J, Stevens PM. 2008. Guided growth for fixed knee flexion deformity. J Pediatr Orthop. 28(6):626-31. doi: 10.1097/BPO.0b013e318183d573
[33]Macwilliams BA, Harjinder B, Stevens PM. 2011. Guided growth for correction of knee flexion deformity: a series of four cases. Strategies Trauma Limb Reconstr. 6(2):83-90. doi: 10.1007/s11751-011-0110-7
[34]Kramer A, Stevens PM. 2001. Anterior femoral stapling. J Pediatr Orthop. 21(6):804-807.
[35]Stiel N, Babin K, Vettorazzi E, Breyer S, Ebert N, Rupprecht M, Stuecker R, Spiro AS. 2018. Anterior distal femoral hemiepiphysiodesis can reduce fixed flexion deformity of the knee: a retrospective study of 83 knees. Acta Orthop. 89(5):555-559. doi: 10.1080/17453674.2018.1485418
[36]Al-Aubaidi Z, Lundgaard B, Pedersen NW. 2012. Anterior distal femoral hemiepiphysiodesis in the treatment of fixed knee flexion contracture in neuromuscular patients. J Child Orthop. 6(4):313-8. doi: 10.1007/s11832-012-0415-1
[37]Lesiak AC, Esposito PW. 2014. Progressive valgus angulation of the ankle secondary to loss of fibular congruity treated with medial tibial hemiepiphysiodesis and fibular reconstruction. Am J Orthop (Belle Mead NJ). 43(6):280-3.
[38]Noonan KJ, Feinberg JR, Levenda A, Snead J, Wurtz LD. 2002. Natural history of multiple hereditary osteochondromatosis of the lower extremity and ankle. J Pediatr Orthop. 22(1):120-4.
[39]Driscoll MD, Linton J, Sullivan E, Scott A. 2014. Medial malleolar screw versus tension-band plate hemiepiphysiodesis for ankle valgus in the skeletally immature. J Pediatr Orthop. 34(4):441-6. doi: 10.1097/BPO.0000000000000116
[40]Inan M, Chan G, Littleton AG, Kubiak P, Bowen JR. 2008. Efficacy and safety of percutaneous epiphysiodesis. J Pediatr Orthop. 28(6):648-51. doi: 10.1097/BPO.0b013e3181832475
[41]Saran N, Rathjen KE. 2010. Guided growth for the correction of pediatric lower limb angular deformity. J Am Acad Orthop Surg. 18(9):528-36. doi: 10.5435/00124635-201009000-00004
[42]Schroerlucke S, Bertrand S, Clapp J, Bundy J, Gregg FO. 2009. Failure of Orthofix eight-Plate for the treatment of Blount disease. J Pediatr Orthop. 29(1):57-60. doi: 10.1097/BPO.0b013e3181919b5
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