Genu varum and genu valgum. Another look

Guided growth: indications and techniques for correction of knock knees and bowlegs

PURPOSE OF REVIEW

Lower extremities axis alterations are a frequent cause for consultation in the medical practice of the care of paediatric patients. When it corresponds to pathological situations, guided growth surgery has been positioned as a possibility of well tolerated, reproducible and predictable resolution. For this reason, its use has increased significantly in recent years. In this review, its current indications, preoperative study, results and complications described in the updated literature will be discussed.

RECENT FINDINGS

The success of the technique remains high in the current literature, expanding the technique to other segments and disorders, and describing new ways of performing tension band with sutures. In addition, there is an increase in its incidence and a decrease in the associated hospitalized days, which can associate with techniques of lower morbidity.

SUMMARY

As guided growth surgery allows for successful correction of axis alterations, to achieve this, it is important to know the main indications, preoperative analysis and theoretical bases on which this technique is based, to carry it out in an adequate and timely manner, seeking an adequate resolution of the child's problem.

The natural history of "bow legs" and "knock knees" in childhood

Since it is still quite prevalent in many communities to see cases of bow legs and knock knees treated with a variety of different shoes and contraptions, the author was prompted to do a retrospective review of patients primarily complaining of either bow legs or knock knees in childhood. The data generated was then compared with a large number of consecutive operations done at Akron Children's Hospital Medical Center, and with data on 600 control normal males and females who did not complain about their knees. Based on a review of 265 children with bow legs and 336 with knock knees, this comparison allowed for the definition of the natural history of these conditions. It was found that treatment was superfluous, unnecessary, and did not alter the natural history. It was found that, in children under two years of age, there is a distinct "varoid" phase that is subsequently followed by a "valgoid" phase to age ten. By skeletal maturity, only minor degrees of bow legs or knock knees were present, and no case necessitated any further attention.