Genu Valgum

BackgroundIdiopathic genu valgum is a frequently diagnosed growth disorder in adolescence. Whenever the possibilities of conservative therapy have been exhausted, leg straightening by means of hemiepiphysiodesis has become the standard form of treatment. Because of their flexible screw-plate connection, eight-Plates have been reported in the literature to lead to lower complications regarding implant loosening and fracture compared to other implants. The aim of this retrospective survey was to analyse our own patient population who were treated for genu valgum by means of temporary hemiepiphysiodesis near the knee using eight-Plates to modulate growth.MethodsBetween July 2007 and July 2015, 198 eight-Plates were implanted near the knee in 132 children suffering from genu valgum to modulate growth. Depending on the deformity analysis, an eight-Plate was implanted on the distal medial femur and/or the proximal medial tibia. By December 2015, they had been removed from 105 patients. The etiology of genu valgum was mainly idiopathic or associated withobesity. Evaluation was carried out clinically and radiologically (whole-leg X-ray in standing) including determination of the joint angles.ResultsThe median follow-up period was about 46 months (12-102 months). The median age at implantation was 12.7 +/-6.76 years. Of the 105 patients, 45.7% (n = 48) were girls. The eight-Plates remained in place for a median period of 13 +/-1.76 months. Irrespective of the location of hemiepiphysiodesis, the intermalleolar distance was corrected to a median of 0 +/-2.1 cm while the anatomical femorotibial angle was corrected by on average 9 +/-2.7 °Mechanical lateral distal femoral angle changed an average 7 +/- 7.72 degrees. Medial proximal tibial angle changed an average 4 +/- 6.02 degrees. Complications necessitating surgery occurred in 2.8% of cases (1 wound infection, 3 corrective osteotomies following overcorrection).ConclusionTemporary hemiepiphysiodesis using eight-Plates is a gentle, simple and effective procedure used to treat genu valgum by modulating growth. Slight overcorrection is desirable due to the rebound phenomenon, especially in young patients with high growth potential and risk groups such as obese children. In adolescents with only low growth potential (older than 14 years), owing to the low correction potential, the indication should be strictly reviewed and the possible failure of therapy should be discussed with the patient. No differences were observed regarding the location of the implanted eight-Plates (femoral or tibial).

PurposeTibial condylar valgus osteotomy (TCVO) is a type of opening-wedge high tibial osteotomy for advanced medial knee osteoarthritis (OA) with subluxated lateral joint. We report the concept, the current surgical technique with a locking plate, and the short-term clinical and radiological results of this procedure.Methods11 knees with medial OA and a widened lateral joint were treated by TCVO (KL stage III: 6, IV: 5). In this procedure, by the L-shaped osteotomy from the medial side of the proximal tibia to the intercondylar eminence and the valgus correction, lateralization of the mechanical axis and reduction of the subluxated lateral joint are obtained with early postoperative weight-bearing. Before, 6 months, 1, and 5 years after the operation, a visual analog scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), alignment of the lower extremity, and congruency and stability of the femorotibial joint were investigated.ResultsThe VAS improved from an average of 73 mm to 13 mm, and the total WOMAC score from 52 to 14 before to 5 years after the operation, respectively. The mechanical axis changed from 1 to 60%, and the FTA changed from 186° to 171°. The joint line convergence angle (JLCA) changed from 6° to 1°, and the angle difference of JLCA between varus and valgus stress improved from 8° to 4° after the procedure.ConclusionImprovements in pain and activities of daily living were observed by TCVO along with valgus correction of the lower extremity and stabilization of the femorotibial joint.

BackgroundTemporary hemiepiphysiodesis (TH) using an eight-Plate implant is one of the most common surgeries used for the correction of coronal angular deformities around the knee in adolescents. However, few studies have focused on children aged less than 10 years treated with TH using an eight-Plate implant. The purpose of this study was to investigate the efficacy, correction velocity, and complications of TH with an eight-Plate implant as well as the occurrence of rebound and risk factors in this population.MethodsThis retrospective study included a total of 135 physes (101 knees) from 66 children (mean age of 4.69 years old, range from 1 to 10 years old) who underwent TH with an eight-Plate implant to correct coronal genu angular deformities in our hospital. Related clinical factors were recorded and analysed by multivariable linear and logistic regression models.ResultsThe mean deformity correction period was 13.26 months, and the mean follow-up after eight-Plate removal was 12.71 months. In all, 94.06% (95/101 knees) of the genu angular deformities were completely corrected. Non-idiopathic genu angular deformity was found to be an independent risk factor for deformity correction failure (odds ratio (OR) = 2.47). The femoral correction velocity was significantly higher than the tibial correction velocity (1.28° vs. 0.83° per month, p ConclusionsTH using an eight-Plate implant is an effective procedure for coronal genu angular deformities with a low incidence of complications and rebound in patients younger than 10 years old. For this population, TH using an eight-Plate should be considered as soon as the deformity stops responding to conservative treatments. The parents of children younger than 10 years of age with non-idiopathic deformities should be informed preoperatively that the deformity may be prone to correction failure or screw loosening after eight-Plate implantation.

PurposeKnee coronal angular deformities are a frequently encountered challenge in paediatric orthopaedic practice. When surgical treatment is indicated, guided growth techniques have many advantages in managing these conditions. The purpose of this study is to evaluate the outcome of a modification of the original Percutaneous Epiphysiodesis using Transphyseal Screw (PETS) technique described by Métaizeau as a minimally invasive surgical approach in the treatment of knee angular deformities.MethodsIn this prospective study, a total of 14 patients (comprising 25 limbs) with a coronal plane deformity of the knee underwent percutaneous transphyseal screw hemiepiphysiodesis. Operative time is assessed. The patients were subsequently monitored for an average duration of 28 months. The radiological assessment was conducted using the metrics of MAD (mechanical axis deviation), mLDFA (mechanical lateral distal femoral angle), and MPTA (medial proximal tibial angle). Clinical assessment included the intermalleolar distance (IMD) and intercondylar distance (ICD). The functional outcome evaluation was conducted using a modified version of the original Böstman score, taking into account the different age groups of the targeted cases.ResultsIn the genu valgum group, the mean preoperative values were: intermalleolar distance (IMD) 16.9 cm, mechanical axis deviation (MAD) 2.6 cm, and mechanical lateral distal femoral angle (mLDFA) 84°. In the genu varum group, the mean preoperative values were: intercondylar distance (ICD) 8.4 cm, mechanical axis deviation (MAD) -3.0 cm, and medial proximal tibial angle (MPTA) 77.8°. The mean operative time was 15 min. All radiological and clinical outcome measures showed significant improvement (P ≤ 0.05). At 24 months, 96% of cases achieved an excellent Böstman knee score. One patient reached skeletal maturity before full correction could be achieved. No other complications were observed.ConclusionThis modification of the Métaizeau technique retains the advantages of PETS and offers a simplified approach that may reduce operative time and fluoroscopy use. Our results suggest that it is a safe and effective option for correcting coronal angular knee deformities in children. Further comparative studies are needed to confirm these potential benefits.