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Tirta M, Hjorth MH, Jepsen JF, Kold S, Rahbek O. Staples, tension-band plates, and percutaneous epiphysiodesis screws used for leg-length discrepancy treatment: a systematic review and proportional meta-analysis. Acta Orthop 2024; 95:415-424. [PMID: 39023429 PMCID: PMC11257069 DOI: 10.2340/17453674.2024.41104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/26/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND AND PURPOSE The primary aim of this systematic review and meta-analysis was to evaluate the success rate of 3 different epiphysiodesis techniques with implant usage for the treatment of leg-length discrepancy (LLD) in the pediatric population. The secondary aim was to address effectiveness (final LLD) and the reported complications of staples, tension-band plates (TBP), and percutaneous epiphysiodesis screws (PETS). METHODS In this systematic review we searched MEDLINE (PubMed), Embase, Cochrane Library, Web of Science and Scopus for studies on skeletally immature patients with LLD treated with epiphysiodesis with an implant. The extracted outcome categories were effectiveness of epiphysiodesis (LLD measurements pre-/postoperatively, successful/unsuccessful) and complications that were graded on severity. RESULTS 44 studies (2,184 patients) were included. 455 underwent epiphysiodesis with PETS, 578 patients with TBP, and 1,048 with staples. Successful epiphysiodesis was reported in 76% (95% confidence interval [CI] 61-89) with PETS (9 studies), 67% (CI 54-79) with TBP (10 studies), and 51% (CI 28-65) with Blount staples (8 studies). From pooled analysis, the severe complications rate was 7% for PETS, 17% for TBP, and 16% for Blount staples. Angular deformity was reported in 4% after PETS, 10% after TBP, and 17% after Blount staples. CONCLUSION Our results showed that epiphysiodesis with PETS implants was the most successful technique. PETS had a higher success rate, fewer severe complications, and a lower proportion with angular deformity.
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Affiliation(s)
- Maria Tirta
- Interdisciplinary Orthopedics, Aalborg University Hospital.
| | | | | | - Søren Kold
- Interdisciplinary Orthopedics, Aalborg University Hospital
| | - Ole Rahbek
- Interdisciplinary Orthopedics, Aalborg University Hospital
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Vasudevan RS, Zogby AM, Wilps T, Paras T, Pennock AT. Change in Posterior Tibial Slope Angle After Displaced Pediatric Tibial Tubercle Fracture: A Model for Growth Modulation in the ACL-Deficient Knee. Orthop J Sports Med 2024; 12:23259671231224498. [PMID: 38327617 PMCID: PMC10848788 DOI: 10.1177/23259671231224498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/16/2023] [Indexed: 02/09/2024] Open
Abstract
Background Increased posterior tibial slope angle (PTSA) has been shown to be an important risk factor for anterior cruciate ligament (ACL) injury. PTSA modulation is not utilized routinely to reduce risk of primary rupture or graft failure. Displaced tibial tubercle (TT) fractures in the skeletally immature are associated with potential growth arrest and may be used as a model to study PTSA changes in this setting. Purpose/Hypothesis To quantify the change in PTSA (ΔPTSA) after operative treatment of displaced TT fractures in skeletally immature patients. It was hypothesized that there would be a progressive decrease in PTSA after TT injury and that rate of ΔPTSA would be highest during peak growth velocity. Study Design Case series; Level of evidence, 4. Methods Included were 22 patients (n = 23 knees; mean chronological and bone age at injury, 14 years; 86% male) who underwent surgery for displaced TT fracture. PTSA was measured on lateral radiographs at time of surgery and subsequent follow-up, and bone age at the time of injury was determined using radiographic standards. The rate of ΔPTSA for individual patient, total cohort, and sex-based subgroup trends were determined via linear regression (degrees per month; positive value indicates relatively anterior). Individual patient regression coefficients were averaged into bone age cohorts. Results Average follow-up was 17 months (range, 6-52 months). The mean PTSA was -12°± 2.4° at the time of injury, and the mean ΔPTSA for the cohort was 0.30°± 0.31° per month (range, -0.27° to 0.97° per month). Linear regression demonstrated a significant relationship between months postfixation and PTSA, demonstrating a ΔPTSA of 0.31° per month (95% confidence interval [CI], 0.24° to 0.38°; P < .001). The highest ΔPTSA was seen at bone age 14 years (mean, 0.58°± 0.44° per month). The mean absolute change in PTSA from injury to final follow-up was 4.1° (range, -3.4° to 21°). Conclusion Our data suggested that PTSA becomes more anterior after operatively treated pediatric TT fractures and that ΔPTSA may be influenced by bone age. This concept may be useful in considering surgical modulation of excessive PTSA in the pediatric ACL-deficient knee.
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Affiliation(s)
- Rajiv S. Vasudevan
- Department of Orthopaedic Surgery, Balboa Naval Medical Center, San Diego, California, USA
| | - Andrew M. Zogby
- Department of Orthopaedic Surgery, Balboa Naval Medical Center, San Diego, California, USA
| | - Tyler Wilps
- Department of Orthopaedic Surgery, Balboa Naval Medical Center, San Diego, California, USA
| | - Tyer Paras
- Department of Orthopaedic Surgery, Balboa Naval Medical Center, San Diego, California, USA
| | - Andrew T. Pennock
- Division of Orthopedic Surgery, Rady Children's Hospital, San Diego, California, USA
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Vogt B, Rölfing JD, Rödl R, Tretow H. [Options and limits of leg length correction in paediatric orthopaedics]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:719-728. [PMID: 37561147 DOI: 10.1007/s00132-023-04420-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/11/2023]
Abstract
For paediatric orthopaedic surgeons treating leg length discrepancy, knowledge of the available procedures and their options and limits is just as important as mastery of the very different surgical methods and implants, as well as the possible complications, in order to be able to advise and treat the children and adolescents and their parents comprehensively and in the best interests. Both the growth inhibiting procedures and the complex bone lengthening procedures require a great deal of experience to successfully guide patients and families through what is often a lengthy and sometimes complicated treatment process. Careful preoperative indications and planning, precise surgical techniques with suitable instruments and implants, and attentive postoperative check-ups are mandatory prerequisites for the desired therapeutic success.
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Affiliation(s)
- Björn Vogt
- Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, 48149, Münster, Deutschland.
| | - Jan Duedal Rölfing
- Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, 48149, Münster, Deutschland
- Children's Orthopaedics and Reconstruction, Aarhus University Hospital, Aarhus, Dänemark
| | - Robert Rödl
- Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, 48149, Münster, Deutschland
| | - Henning Tretow
- Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, 48149, Münster, Deutschland
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Vogt B, Hvidberg E, Rölfing JD, Gosheger G, Møller-Madsen B, Abood AA, Weyer-Elberich V, Laufer A, Toporowski G, Roedl R, Frommer A. Radiographic reference values of the central knee anatomy in 8-16-year-old children. Acta Orthop 2023; 94:393-398. [PMID: 37522246 PMCID: PMC10388364 DOI: 10.2340/17453674.2023.15336] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND AND PURPOSE For correction of leg-length discrepancy or angular deformity of the lower limb in skeletally immature patients temporary or permanent (hemi-)epiphysiodesis can be employed. These are reliable treatments with few complications. Recently, radiographic analysis of treatment-related alterations of the central knee anatomy gained interest among pediatric orthopedic surgeons. To date the comparison and adequate interpretation of potential changes of the central knee anatomy is limited due to the lack of defined standardized radiographic references. We aimed to establish new reference values of the central knee anatomy. PATIENTS AND METHODS A retrospective analysis of calibrated longstanding anteroposterior radiographs of 254 skeletally immature patients with a chronological age ranging from 8 to 16 years was conducted. The following radiographic parameters were assessed: (1) femoral floor angle, (2) tibial roof angle, (3) width at femoral physis, and (4) femoral notch-intercondylar distance. RESULTS All observed radiographic parameters were normally distributed with a mean age of 12.4 years (standard deviation [SD] 2, 95% confidence interval [CI] 12.2-12.6). Mean femoral floor angle was 142° (SD 6, CI 141.8-142.9), mean tibial roof angle was 144° (SD 5, CI 143.7-144.1), mean width at femoral physis was 73 mm (SD 6, CI 72.8-73.9), and mean femoral notch-intercondylar distance was 8 mm (SD 1, CI 7.5-7.7). The estimated intraclass correlation coefficient values were excellent for all measurements. CONCLUSION This study provides new radiographic reference values of the central knee anatomy for children between 8 and 16 years and we suggest considering values within the range of 2 SD as the physiological range.
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Affiliation(s)
- Bjoern Vogt
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany.
| | - Emma Hvidberg
- Danish Pediatric Orthopedic Research, Aarhus University Hospital, Denmark; Children's Orthopaedics and Reconstruction, Aarhus University Hospital, Denmark
| | - Jan Duedal Rölfing
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany; Danish Pediatric Orthopedic Research, Aarhus University Hospital, Denmark; Children's Orthopaedics and Reconstruction, Aarhus University Hospital, Denmark
| | - Georg Gosheger
- General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Germany
| | - Bjarne Møller-Madsen
- Danish Pediatric Orthopedic Research, Aarhus University Hospital, Denmark; Children's Orthopaedics and Reconstruction, Aarhus University Hospital, Denmark
| | - Ahmed A Abood
- Danish Pediatric Orthopedic Research, Aarhus University Hospital, Denmark; Children's Orthopaedics and Reconstruction, Aarhus University Hospital, Denmark
| | | | - Andrea Laufer
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Germany
| | - Gregor Toporowski
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Germany
| | - Robert Roedl
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany
| | - Adrien Frommer
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Germany
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Erdal OA, Gorgun B, Razi O, Sarikaya IA, Inan M. Effects of tension band plating on coronal plane alignment of lower extremities in children treated for idiopathic limb length discrepancy. J Child Orthop 2022; 16:505-511. [PMID: 36483641 PMCID: PMC9723863 DOI: 10.1177/18632521221135192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE One of the most common treatment methods for moderate limb length discrepancy in children is growth modulation using tension band plating. Coronal plane deformities after tension band plating for limb length discrepancy have been documented as an important complication in articles involving heterogeneous groups consisted of both idiopathic cases and patients with pathological physes. The aim of the study was to determine the rate of coronal plane deformities after treatment of a homogeneous group of idiopathic limb length discrepancy cases with tension band plating and to compare screw constructs of medial and lateral plates. METHODS Patient files were retrospectively reviewed for amount of limb length discrepancy, anatomical femorotibial angle, mechanical lateral distal femoral angle, mechanical medial proximal tibial angle, and inter-screw angles of each plate on both sides of the tibiae and femora. Measurements at each follow-up period were compared to each other. RESULTS A total of 26 patient files (37 bones) were included to the study. The mean age was 10.5 years. The mean limb length discrepancy was 27.5 mm. Implants were removed after mean 34.5 months. The mean follow-up period was 58.5 months. There was no significant difference in inter-screw angle on each side of the bones at the time of implantation and in lower limb alignments during follow-up. CONCLUSION Treatment of mild-to-moderate idiopathic limb length discrepancy with tension band plating in children was found to be safe against any coronal plane deformity during follow-up until skeletal maturity. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Ozan A Erdal
- Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Istanbul, Turkey,Ozan A Erdal, Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Dikilitas Mah. Hakki Yeten Cad. No 10/D 34365 Besiktas, Istanbul, Turkey.
| | - Baris Gorgun
- Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Istanbul, Turkey
| | - Ozan Razi
- Ministry of Health, Burhan Nalbantoglu State Hospital, Lefkosa, Cyprus,Ozan A Erdal, Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Dikilitas Mah. Hakki Yeten Cad. No 10/D 34365 Besiktas, Istanbul, Turkey.
| | - Ilker A Sarikaya
- Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Istanbul, Turkey
| | - Muharrem Inan
- Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Istanbul, Turkey
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