Abstract
PurposeFor correction of angular deformity, tension band plating has been proposed as a safe and minimally invasive technique. The purpose of this study was to assess the experiences and report the rate of correction obtained with this procedure in patients with idiopathic genu valgum.MethodsThis study was a retrospective review of 47 valgus deformities of the knee treated with medial hemiepiphysiodesis using a tension band plate. The tibiofemoral angle (TFA) and the anatomic lateral distal femoral angle (aLDFA) were assessed on anteroposterior (AP) radiographs of the lower extremity taken at multiple time intervals. The values were charted to determine the change in orientation of the joint surface over time. Pearson’s correlation was used to analyze the correction over time. A subanalysis was performed evaluating the effect of age and the number of plates utilized.ResultsA total of 47 deformities in 25 patients were reviewed. The average time of follow-up from index surgery was 12.7 months, with an average correction of 0.96° every 3 months or 3.8° per year. The aLDFA corrected at a faster rate in knees with two plates per hemiepiphysiodesis than those with one plate, 4.2° and 3.3° per year, respectively (P = 0.035). Girls <11 years of age and boys <13 years of age corrected at a rate of 4.5°, while older children corrected at a rate of 3.4° per year (P = 0.39). There were no complications or instrumentation breakages.ConclusionHemiepiphysiodesis with tension band plating provides an effective and predictable correction of idiopathic genu valgum. Two plates appear to provide a greater rate of correction. There is also a trend toward faster correction in younger patients as well.
Highlights
IntroductionThe alignment of the knee should follow a predictable change from varus to valgus as described by Salenius and Vankka [1]
During early childhood development, the alignment of the knee should follow a predictable change from varus to valgus as described by Salenius and Vankka [1]
It has been well demonstrated that hemiepiphysiodesis, regardless of the technique, is a safe and easy approach to address angular deformity of the knee
Summary
The alignment of the knee should follow a predictable change from varus to valgus as described by Salenius and Vankka [1]. At approximately 6 years of age, this transition stabilizes at approximately 5–7° of tibiofemoral valgus. The presence of deformity leads to abnormal joint overload, which can result in future degenerative joint disease. The deformity can lead to cosmetic concerns, functional limitations, and abnormal gait mechanics [2,3,4,5]. The major principles began to take shape with the studies of Phemister and Haas, early in the 20th century [6, 7]. Through their different studies, they showed that, by altering physeal growth, they could achieve angular correction that was simpler and
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