Angular Deformities Of Knee Research Articles

Transphyseal Hemiepiphysiodesis: Is it Truly Reversible?

Although numerous studies reported the efficacy of percutaneous epiphysiodesis using transphyseal screws (PETS) in correcting angular knee deformities, many surgeons refrained from using it in younger children because of a lack of objective evidence of reversibility. Our hypothesis is that PETS is both truly reversible and effective. Twenty-one patients aged 8 to 13 years (36 lower limbs LL) with coronal plane knee deformity were enrolled into this prospective case series from January 2021 to September 2023. Besides the routine monitoring of PETS efficacy, low dose CT knee of 32 treated physes was done 6 months after screw removal. In addition, lower limb length, mechanical lateral distal femur angle (mLDFA), and medial proximal tibial angle (MPTA) were recorded preoperatively and 6 to 17 months after screw removal for 24 LL to investigate physis behavior, technique reversibility, and resumption of bone growth after screw removal. The mean mechanical axis deviation (MAD) correction rate was 3.46mm/mo and 1.78mm/mo for genu valgum and genu varum patients, respectively. No physeal bony bars could be detected 6 months after screw removal for all patients. Out of 24 physis that underwent computerized radiography (CR) of the whole lower limb, 12 LL resumed their growth, 4 were stationary, while 8 were excluded due to inadequate calibration. A single physis showed rebound deformity, and another showed overcorrection in the genu valgum group. In addition to being a highly effective method of hemiepiphysiodesis, PETS was found to be reproducible, safe, and reversible when used in the juvenile and early adolescent pediatric population. IV-Prospective case series.

Comparative Study between Eight Plate and Staples in the Management of Angular Knee Deformities in Children Older than 3 Years Attending Suez Canal University Hospital

Comparative Study between Eight Plate and Staples in the Management of Angular Knee Deformities in Children Older than 3 Years Attending Suez Canal University Hospital

Correction of angular deformities of knee in children using guided growth technique 8-plates

Background: Angular deformities of the knee, a common problem in the early years of life are frequently encountered in paediatric orthopaedics not only because of very high incidence of these deformities but also because of major parental concern in the present highly demanding sports oriented society. The purpose of this study was to discuss the role of 8-plate hemi-epiphysiodesis to correct angular deformities of the knee joint. Materials and methods: The study had total of 25 children with total 45 knees having varus or valgus angular deformities, of which 20 were bilateral and 5 were unilateral. All patients were symptomatic and were followed for regular intervals of 6 months to observe the change of the deformity. Results: The mean preoperative genu valgum deformity was 19.79 degrees (ranging from 13-35 degrees) and genu varum deformity was 17.29 degrees (9-25 degrees). 91.1% of the deformed knees were corrected fully at the mean final follow up period of 27 months, neutralizing the mechanical axis and correction of the deformity. Conclusions: 8-plate is technically simple and potent tool to correct genu valgum and varus deformities around knee in children without need for osteotomies in many children. Based on the low complication rate, patient acceptance, and the rapidity of improvement, this technique should be used as treatment of choice.

Frontal Plane Angular Knee Deformities in School Children in Kribi, South Region of Cameroon

Bone problems such as angular deformities of the knee are common in children in Africa. The aim of this survey was to study epidemiologic aspects of frontal plane angular knee deformities in school children in Kribi. A total of 860 school children in Kribi aged 3 to 18 years were surveyed in a cross-sectional descriptive study from December 2019 to March 2020. Each child was examined. Intercodylar distances, intermalleolar distances and the tibiofemoral angles were assessed. The type of knee deformity in the frontal plane was determined from the children`s tibiofemoral angles and compared with reference values of normal children in the same age ranges. One hundred and fourty two (142, 16.5%) children surveyed presented with frontal plane knee deformities, with genu varum representing 68.0% (96 cases) of the deformities. The prevalence of these deformities in school children in Kribi varied significantly with age. We did not find any significant difference in the variation of these deformities with gender or ethnic groups. We identified some frontal plane angular knee deformities, including bilateral deformities being predominant 90.71% (127 cases). The mean body mass index was higher than those of normal children. 15.5% (22) of them presented with associated deformity in the sagital plane, dominated by bilateral genu recurvatum and 33.8% (48) of them presented with associated rotational knee deformities, dominated by bilateral medial rotation. Frontal plane knee angular deformities are common amongst school children in Kribi. Their prevalence is 16.51% (142 cases). This prevalence varies with ages. Sagittal plane and rotational plane deformities are equally present in children presenting with these deformities. Keywords: Bone, Children, Deformities, Cameroon.

Endoscopic Physeal Bar Resection Combined with Guided Growth using Local Fat Graft Interposition and Post-Operative CT Assessment for the Treatment of Genu Valgus: a case repor

Distal femur physeal arrest due to physeal bar formation with progressive deformities is an unwanted complication following injury to the femur. Various techniques of physeal bar resection, either using open techniques or endoscopic methods, have been described in the available literature. The associated angular deformities could be addressed either with osteotomy in acute correction or gradual correction with an external fixator or guided growth principle. We would like to recommend the use of fat tissues from the surgical wound used for the guided growth and evaluation of the recurrence of the physeal bar via computed tomography in our case. To our knowledge there is no previous reports using similar approach. We shall share case of a severely comminuted distal femoral physeal injury Salter-Harris IV complicated with central physeal bar causing growth disturbance and angular knee deformity treated via endoscopic resection surgery and simultaneous 8-plate insertion for which has shown a good radiological and functional outcome.

Subtalar axis determined by combining digital twins and artificial intelligence: influence of the orientation of this axis for hindfoot compensation of varus and valgus knees

Previous studies evaluating hindfoot and knee alignment have suggested compensation between the knee and the hindfoot deformities. However, these studies did not investigate the influence of the orientation of the subtalar axis on the results. Using computed tomography data of patients without osteoarthritis, digital twins, and artificial intelligence, we identified the orientation of the axis of the subtalar joint. Compensation was evaluated in the subtalar joint according to angular knee deformity and subtalar axis direction. With the inclination angle defined as the angle between the axis and the XY plane (horizontal) and the deviation angle defined as the angle between the projection of axis on the XZ plane, the inclination angle of the subtalar helical axis showed an average angle of 35.3° (range 5° to 48°). The mean deviation angle for the helical axis was 6.4° (range - 4° to + 12°). Our findings indicated that an increase of the inclination angle of the subtalar axis tends to limit adjustment in the hindfoot alignment toward re-balance of the whole lower limb toward a neutral weight-bearing axis when malalignment of the knee occurs. Malalignment of the knee and different compensations in the hindfoot contribute to various combined deformities in the population: associated valgus or varus deformities and inverse associations of varus/valgus deformities.

Hemiepiphysiodesis for coronal angular knee deformities: tension-band plate versus percutaneous transphyseal screw

Pediatric coronal plane knee deformities can be treated surgically using hemiepiphysiodesis. The two leading techniques used for hemiepiphysiodesis are: tension-band plates (TBP) and percutaneous transphyseal screws (PETS). We hypothesized that PETS would lead to faster guided correction of angular knee deformities than TBP. A retrospective cohort of 35 patients treated with either TBP or PETS in one medical institution was established. The cohort included both genu varum and genu valgum of both primary and secondary etiologies. We first compared the treatment groups for differences in demographic and malalignment characteristics. Then, we compared the treatment groups for differences in operation-related outcomes, radiological mechanical correction and complication rates. We found that the use of PETS, compared to TBP, was associated with a faster implantation surgery and a shorter interval between implantation and removal, i.e., faster correction. Furthermore, PETS were associated with faster correction rates of the mechanical axis deviation, lateral distal femoral angle and medial proximal tibial angle. No significant differences in complication rates were found between the two treatments. PETS provided a faster correction of angular knee deformities compared to TBP at similar complication rates. Hence, PETS could be considered a superior technique for hemiepiphysiodesis.

Correction of the Lower Extremity Mechanical Axis Deviation in Children with Angular Deformities of the Knee treated with Guided Growth Hemiepiphysiodesis

Background: Correction rate of angular deformities around the knee following hemiepiphysiodesis has been variable in the literature. This study aims to report the rate of mechanical axis after hemiepiphysiodesis around the knee. Factors associated with differences in correction rate are also reported. Methods: Records of skeletally immature patients, who underwent hemiepiphysiodesis for either genu valgum or genu varum between 2004 and 2018, were reviewed. For all patients, temporary hemiepiphysiodesis was performed using tension band plating. Radiographs at preoperative visit as well as each follow up visit were reviewed. Lower extremity mechanical axis deviation …

TKA in the treatment of bilateral dysplasia epiphysealis hemimelica (Trevor\u2019s Disease) of the knee in a 50-year-old man: a case report

BackgroundDysplasia epiphysealis hemimelica (DEH), also known as Trevor’s disease, is a rare skeletal developmental disorder affecting the epiphyses in pediatric patients. DEH is characterized by an asymmetric osteochondral overgrowth arising from either the medial or lateral portion of an epiphysis and usually occurs in the joints of lower limbs, most commonly in the knees and ankles. However, bilateral involvement in an adult is extremely rare, and total knee arthroplasty (TKA) for a patient with DEH has been reported only once before.Case presentationHere, we present a case of bilateral DEH of the knees that caused varus deformity and dysfunction of the lower limbs in a 50-year-old man. TKA was performed for treatment, and the patient had satisfactory function with no angular knee deformity and a normal range of motion after 1 year of follow-up.ConclusionsThe patient in this case exhibited its specific clinical and radiological features of late-term DEH and TKA was proved to be an appropriate procedure for treating the severe deformity caused by this rare disease.

Growth modulation in idiopathic angular knee deformities: is it predictable?

PurposeTo evaluate the temporal and spatial sequence of events following temporal hemiepiphysiodesis in idiopathic knee varus/valgus.MethodsThis is a retrospective multicentre study on 372 physes in 206 patients. The average rate of correction (ROC) was calculated; univariate and multivariate analysis were performed.ResultsIn all, 92% of the femoral physes were followed for more than one year/reached skeletal maturity. Of those, 93% were corrected to a mechanical lateral distal femoral angle (mLDFA) of 85° to 89°; 2% did not, while 5% were over-corrected. A total of 92% of the tibial physes were followed for more than one year/reached skeletal maturity. Of those, 92% were corrected to a mechanical medial proximal tibial angle (mMPTA) of 85° to 89°; 2% did not, while 6% were over-corrected. Factors significantly influencing success and ROC were age, direction and magnitude of deformity. Femoral ROC was significantly faster than tibial ROC: 0.85° versus 0.78°/month, respectively (p = 0.05). Femoral valgus ROC was significantly faster than varus ROC: 0.90° versus 0.77°/month, respectively (p = 0.04). A constant was derived to calculate the amount of correction. Significant correlation was found between calculated and actual mLDFA in valgus deformity during the first year (r = 0.58 to 0.87, p < 0.01). Calculated mLDFA of varus deformity did not correlate with actual mLDFA. Significant correlation was found when calculating mMPTA correction in all deformities.ConclusionsFemur corrects faster than tibia; valgus femoral deformities are corrected faster than varus. Valgus correction in the distal femur/proximal tibia as well as varus correction in the tibia in idiopathic patients is highly predictable. The constant derived is the first tool which enables predicting and monitoring amount of correction in hemiepiphysiodesis when correcting angular deformities around the knee.Level of EvidenceIV

Paediatric musculoskeletal disease in Kumi District, Uganda: a cross-sectional survey

The purpose of this study is to estimate the burden of musculoskeletal disease among children treated in Kumi District, Uganda, to inform training, capacity-building efforts, and resource allocation. We conducted a retrospective cohort study by reviewing the musculoskeletal (MSK) clinic and community outreach logs for children (age < 18years) seen at Kumi Hospital in Kumi, Uganda, between January 2013 and December 2015. For each patient, we recorded the age, sex, diagnosis, and treatment recommendation. Of the 4852 children, the most common diagnoses were gluteal and quadriceps contractures (29.4% (95% CI 28.1-30.7%), 96% of which were gluteal fibrosis), post-injection paralysis (12.7% (95% CI 11.8-13.6%)), infection (10.5% (95% CI 9.7-11.4%)), trauma (6.9% (95% CI 6.2-7.6%)), cerebral palsy (6.9% (95% CI 6.2-7.7%)), and clubfoot (4.3% (95% CI 3.8-4.9%)). Gluteal fibrosis, musculoskeletal infections, and angular knee deformities create a large surgical burden with 88.1%, 59.1%, and 54.1% of patients seen with these diagnoses referred for surgery, respectively. Post-injection paralysis, clubfoot, and cerebral palsy were treated non-operatively in over 75% of cases. While population-based estimates of disease burden and resource utilization are needed, this data offers insight into burden of musculoskeletal disease for this region of Sub-Saharan Africa. We estimate that 50% of the surgical conditions could be prevented with policy changes and education regarding injection practices and early care for traumatic injuries, clubfeet, and infection. This study highlights a need to increase capacity to care for specific musculoskeletal conditions, including gluteal fibrosis, post-injection paralysis, infection, and trauma in the paediatric population of Uganda.

Results of Angular Knee Deformities Treated with Temporary Hemiepiphysiodesis by Eight-Plate

Results of Angular Knee Deformities Treated with Temporary Hemiepiphysiodesis by Eight-Plate

Handball and angular knee deformities in schoolgirls

Handball and angular knee deformities in schoolgirls

Guided growth with a noncannulated screw–plate system for angular deformity of the knee

We assessed the result of guided growth for an angular knee deformity using a 3.5-mm noncannulated screw-plate system. Twenty-seven patients with angular deformities (10 distal femora, 13 proximal tibiae, and four both areas) underwent this procedure with the reconstruction plate and two noncannulated screws. Average age at the time of the procedure was 7.8 years and the average follow-up was 25.7 months. Except for one patient (two knees), 25 of 27 deformities showed a resolved outcome with a neutral alignment. The mechanical lateral distal femoral angle changed an average of 8.3° for 13 months and the medial proximal tibial angle changed an average of 7.7° for 11.8 months in the neutral state. The mean angle between the two screws was -2° in immediate postoperative radiographs and 23° in radiographs taken at the latest follow-up. Two patients showed a rebound outcome and one showed a failure of no correction. There was a superficial infection, but no mechanical failure of the screw and the plate was observed. The noncannulated screw-plate system may play a similar role of guided growth, to correct angular knee deformity, although a large series study with a long follow-up is required for a definitive conclusion.

Our Experience with Correction of Angular Deformities of Knee by Flexible Figure of 8-plate Hemiepiphysiodesis

Abstract Background Genu valgum and genu varum deformity in the lower limb in children results in cosmetic problem, gait disturbance, pain and early joint degeneration. Most of them are physiological and improve to the normal adult femorotibial angle before the age of eight years. Persistent deformities are corrected by osteotomy and internal fixation or gradual correction by external fixation. Osteotomy has got its complications. Gradual correction also can be achieved by stapling, percutaneous drill technique and transphysial screw. Stapling has drawbacks related to implant failure including migration and breakage of implants. Drilling and screwing carries risk of permanent growth arrest. The timing of epiphysiodesis has to be perfect otherwise there may be under correction or overcorrection. 8-plate temporary hemi-epiphysiodesis is a new concept and producing good results with less complication. The objective of this study is to reduplicate the results of 8- plate hemiephiphysiodesis on angular deformities of knee joint. Methods We attempted gradual correction through 8-plate in 31 patients with 54 angular deformities around knee. Cases were followed for 38months (range, 24 to 52months) after removal of implants. Measurements were compared pre and postoperatively. Results There was statistically significant improvement in all the outcome measures measured. There was gross reduction of intermalleolar distance and reduction in angular deformity. Conclusions 8-plate hemiepiphysiodesis is an effective means for correcting angular deformity around the knee in skeletally immatured patients.

Epidemiology Of Angular Deformities Of The Knee In Children In Benin, Nigeria

Background: Bony problems such as angular deformities and metabolic bone disease are of high frequency in Nigeria. Objective: The aim of this study was to define the pattern of presentation in children with angular deformities of the knee. Methodology: It was an 18-month prospective study involving children aged between birth and 16 years who presented at the consultant orthopaedic outpatient department with angular deformity of the knee. Results: Rickets was found to be the most common aetiology of angular deformity of the knee and bilateral knee affectation was the most common mode of presentation. Genu valgum was the commonest deformity seen and most patients presented before the age of 5years. Conclusion: Rickets is the most common cause of angular deformity of the knee in patients presenting at the orthopaedic clinics in UBTH, but this may not reflect the true prevalence of angular knee deformities in the community. Sahel Medical Journal Vol. 11 (4) 2008: pp. 114-117

Effect of Body Mass Index (BMI) On Degree of Angular Knee Deformity in Children with Blount\'s Disease.

The aetiology of Blount\'s disease remains unknown, but it is generally agreed that weight bearing plays a role in the pathogenesis of knee deformity in these patients. Our aim was to analyze the effect of Body Mass Index (BMI) on the degree of angular knee deformity in children with clinical and radiological features of Blount\'s disease. This was a prospective analysis which involved 20 patients (38 knees) with clinical and radiological evidence of Blount\'s disease. Forty controls (80 knees) without clinical evidence of knee pathology were recruited for comparison. The Body Mass Index (BMI) was determined for each patient using the Johan Van Hespen BMI calculator. The degree of angular deformity in patients with Blount\'s disease was determined by measuring the intercondylar distance (ICD). Results obtained were subjected to statistical analysis with significance level set at P Keywords : Blount\'s Disease, Body Mass Index, Angular knee deformity Nigeria Journal of Orthopaedics and Trauma Vol. 7 (2) 2008: pp. 76-78

Factors influencing the outcome of elective paediatric orthopaedic operations in Ile-Ife, Nigeria

There is a paucity of published data on the types of paediatric orthopaedic conditions that require surgery and factors influencing their outcome in most parts of Sub-Saharan Africa. This is a necessary audit to improve paediatric orthopaedic practice. We carried out an audit of all elective orthopaedic operations performed in children at Awolowo University Teaching Hospitals Complex in Ile-Ife, Nigeria from January 2000 through December 2005. The aim was to document the clinical outcomes and the factors that influence them. This is with a view to instituting necessary measures to improve paediatric orthopaedic practice in the area. A total of 146 children who had elective operations on 210 limbs were included in the study. Their mean age was 75.6 +/- 66.8 months (range 0.3-396 months). The commonest indications for surgery were angular knee deformities (from Blount's disease and rickets) and club foot. The mean hospital stay before surgery was 12 +/- 8.8 days (range 1-38 days). The mean duration of operation was 78.4 +/- 36 min. (range 30-195 min). The total length of hospitalization was 34.97 +/- 19.91 days in males and 41.97 +/- 25.15 days in females. Wound infection was the commonest postoperative complication (8.2%). The patient's age (P = 0.002), indication for surgery (P = 0.008), length of preoperative hospital stay (P = 0.048), length of operation (P < 0.001) and intraoperative blood loss above 200ml (P < 0.001) were found to be statistically significant factors adversely affecting the surgical wound outcome. We conclude that most of the factors that predicted poor outcome in this study were patient and environment-related and are preventable. There is need to upgrade facilities in health institutions in Nigeria.

Primary angular knee deformities among Nigerian school children

Primary angular knee deformities among Nigerian school children

Dysplasie épiphysaire hémimélique chez une jeune enfant : rôle de l'imagerie par résonance magnétique dans le diagnostic et le suivi

This report describes a sporadic case of dysplasia epiphysealis hemimelica that developed in the proximal tibia of a 21-month-old girl. Three years after the surgical intervention the patient has made complete clinical recovery with a normal range of motion, a walk with no limping or pain, no leg length discrepancy or angular knee deformity. Even though the proximal tibia does not represent an infrequently involved site, we report the clinical, pathological and radiological features of our case both for the extreme rarity of dysplasia epiphysealis hemimelica and the very young age of the patient. The authors underline also the role of magnetic resonance imaging in the diagnosis, management and follow-up of this very rare condition.