Treatment Of Leg Length Discrepancy Research Articles

Updates in the Management of Leg Length Discrepancy: A Systematic Review.

The aim of this study is to comprehensively investigate the recent literature on the management of leg length discrepancy (LLD). A thorough search of pertinent databases was done in order to find studies that satisfied the requirements for inclusion. A thorough search of PubMed, Web of Science, Scopus, and Science Direct was conducted to find pertinent literature. Rayyan Qatar Computing Research Institute (QRCI,Ar Rayyan, Qatar) was utilized during the whole operation.Eight studies, including a total of 345 patients, were included in our data, and 206 (59.7%) of them were males. Percutaneous epiphysiodesis was the surgical intervention of choice in four studies. LLD can be effectively corrected by temporary and permanent epiphysiodesis. One study reported the incidence of angular deformities following temporary epiphysiodesis. Circumferential periosteal and dual tension-band plating significantly reduced LLD, but reported the incidence of an "over-shoot" in some patients. Bilateral motion control shoes and orthotic insole both were found to improve the patient's gait and trunk symmetry, evidenced by longer and faster steps, reduced ground impact at heel strike, and lower peak plantar pressure in both limbs.Our findings confirm that no inferences about the superiority of a particular management approach for the treatment of LLD can be made. The poor quality of the studies shows that more randomized control trials and prospective studies on the subject are required.

The Influence of Temporary Epiphysiodesis of the Proximal End of the Tibia on the Shape of the Knee Joint in Children Treated for Leg Length Discrepancy.

Background: Leg length discrepancy (LLD) is a common problem in the daily clinical practice of pediatric orthopedists. Surgical treatment using LLD temporary epiphysiodesis with eight-plate implants is a minimally invasive, safe, and well-tolerated procedure that provides good treatment effects with a relatively low percentage of complications. The main aim of this retrospective study was to determine the effect of epiphysiodesis on the shape of the proximal tibia. Methods: The retrospective study was based on medical records from 2010 to 2019. Radiographs taken before the epiphysiodesis and at 6-month intervals until the end of the treatment were investigated. A total of 60 patients treated for LLD were included in the study (24 girls, 36 boys). They were divided into three groups depending on the duration of the LLD treatment: group I (18 months), group II (30 months), and group III (42 months of treatment). Radiological parameters were assessed, including the roof angle (D), the slope angles (α and β), and the specific parameters of the tibial epiphysis, namely LTH (lateral tubercle height), MTH (medial tubercle height), and TW (tibial width). Results: The roof angle decreased in all the groups, which was accompanied by an increase in the β or α angle. LTH, MTH and TW also increased, and the differences before and after the treatment for the treated legs were statistically significant in all the studied groups. The greatest change in the shape of the articular surface of the proximal tibia occurred after 42 months of treatment. Conclusions: The study showed that epiphysiodesis affects the proximal tibial articular surface over prolonged treatment. Thus, there is a need for future long-term follow-up studies to elucidate the potential effects of LLD egalization.

Are percutaneous epiphysiodesis and Phemister technique effective in the treatment of leg-length discrepancy? A systematic review.

Epiphysiodesis is considered the preferred treatment for children predicted to have leg length discrepancies (LLDs) 2-5 cm at maturity. The aim of this study was to systematically review the existing literature on the effectiveness of permanent epiphysiodesis for LLD treatment, and secondarily to address the reported complications of permanent epiphysiodesis techniques. This systematic review was performed according to PRISMA guidelines. We searched MEDLINE (PubMed), Embase, Cochrane Library, Web of Science and Scopus for studies on skeletally immature patients with LLD treated with permanent epiphysiodesis. The extracted outcome categories were effectiveness of epiphysiodesis (LLD measurements pre/post-operatively, successful/unsuccessful), physeal fusion/arrest, and complications that were graded on severity. Forty-nine studies (3051 patients) were included, 1550 underwent Phemister/modified Phemister epiphysiodesis and 1501 percutaneous epiphysiodesis (PE). Total successful permanent epiphysiodesis surgeries (16 studies) were 73.7% (516/700). Only 13 out of 23 studies had a mean final LLD of less than 1.5 cm. In total, 17.5% (513/2936) of complications were reported. 57 angular deformities were reported (1.9%). Phemister technique had higher percentage of complications (39%) than PE (19.1%) in total, but when failure to achieve adequate reduction in LLD was not included, complication rates for both were close to 14%. However, severe complications were 10.2% for Phemister group and 5.1% for PE. The high complication rates and the relative low success rate call for optimization of the timing and the applied techniques when treating LLD with permanent epiphysiodesis. Phemister technique was found to have higher percentage of severe complications than PE. Registration: PROSPERO (CRD42023435177).

A RETROSPECTIVE REVIEW OF THE THERAPEUTIC CHALLENGES OF 16 FITBONE INTRAMEDULLARY FEMORAL LENGTHENINGS COMPLETED AT SHEFFIELD CHILDREN'S HOSPITAL BETWEEN 2021 AND 2022

IntroductionAt Sheffield Children's Hospital, treatment of leg length discrepancy is a common procedure. Historically, this has been done with external fixators. With the development in intramedullary technology, internal nails have become the preferred modality for long bone lengthening in the adolescent population. However, it is important to review whether this technology practically reduces the known challenges seen and if it brings any new issues. Therefore, the aim of this review is to retrospectively evaluate the therapeutic challenges of 16 fit-bone intramedullary femoral lengthening's at Sheffield Children's Hospital between 2021–2022.Materials & MethodsThe international classification of function (ICF) framework was used to differentiate outcomes. The patient's therapy notes were retrospectively reviewed for themes around structural, activity and participation limitation. The findings were grouped for analysis and the main themes presented.ResultsThere were 8 males, mean age 17.4 years (range 17–18) and 8 females, mean age 15.9 years (range 14–18). 5 right and 11 left femurs were lengthened. Underlying pathology varied amongst the 16 patients. All patients went into a hinged knee brace post operatively. Structural limitations included: pain, fixed flexion deformity of the knee, loss of knee flexion, quadriceps muscle lag, muscle spasms and gluteal weakness. The primary activity limitation was reduced weight bearing with altered gait pattern. Participation limitations included reduced school attendance and involvement in activities with peers. Access to Physiotherapy from local services varied dramatically. Five of the cohort have completed treatment.ConclusionsAnecdotally, intramedullary femoral lengthening nails have perceived benefits for families compared to external fixators in the adolescent population. However, there remain musculoskeletal and psychosocial outcomes requiring therapeutic management throughout the lengthening process and beyond. Therefore, quantifying these outcomes is essential for measuring the impact on each patient for comparison. To interpret these themes, we need to evaluate the outcomes objectively, this was not done consistently in this review. Future research should look at outcome measures that are sensitive to all aspects of the ICF. With an aim of improving the therapeutic treatment provided and the overall outcome for the children treated.

Outcomes of Limb Lengthening with Computer-assisted Hexapod External Fixators in the Treatment of Fibular Hemimelia.

Fibular hemimelia (FH) represents the most common deficiency of the long bones and is associated with multiple deformities. Reconstructive treatment with external fixators in FH restores normal lower extremity alignment and length with plantigrade feet for a balanced and effective gait. The aim of this study is to evaluate the outcomes of lower limb lengthening and simultaneous tri-plane deformity correction with a computer-assisted hexagonal external fixator in children with FH. A retrospective review was performed for FH cases treated with a computer-assisted hexagonal external fixator in a tertiary referral center. Leg length discrepancy (LLD), interphyseal angles, tibiocalcaneal distances, healing index (HI), and callus shapes were analyzed for radiologic evaluation, and the Pediatric Quality of Life Inventory (PedsQL) was used for functional assessment. Limbs with HI <50 days/cm, PedsQL >75, and without regenerate fractures were considered successful lengthenings. Twenty-four limbs of 23 patients were included. The limbs were lengthened for a mean of 7.24cm (range, 4.7 to 15.6). The initial LLD of 5.6cm (range, 0.5 to 19cm) increased to 1.7cm (range, 0.1 to 6cm), and the mean interphyseal angle was 12.7 degree (range, 1.5 to 54.2 degree), tibiocalcaneal distance was 0.85cm (range, 0.1 to 1.7) at final follow-up. The most common regenerated bone morphology was cylindrical, as seen in 11 limbs (45.8%). The average PedsQL score was 83.5 (range, 69.5 to 96.7). Sixteen limbs (66.7%) had successful lengthening at their first, and 4 limbs (80%) had successful lengthening at their second surgeries. Seven limbs had complications requiring surgical intervention (29.1%), with 3 (12.5%) regenerate fractures after external fixators removal. Limb reconstruction with computer-assisted hexapod fixators is a successful and reliable option for the treatment of LLD in FH, and patients demonstrate good functional outcomes. Surgeons should be aware of potential complications and should utilize prophylactic measures when necessary. Level III, retrospective comparative study.

Patients’ quality of life assessment following treatment of leg length discrepancy in a single center in Riyadh

Objectives: Length disparities of children’s limbs might make it difficult for them to engage in social, recreational, and leisure activities. The main goals of surgical treatment of limb length discrepancy (LLD) are to restore limb function and prevent adverse social effects. The aim of this study was to assess the quality of life (QoL) of children who received therapy for limb length discrepancies. Methods: Twenty participants fit the inclusion criteria and completed the validated and translated version of the electronic questionnaire of the brief version of the world health organization questionnaire for QoL assessment the brief version (WHO-QoL-BREF). Answering the questionnaire was administered by an interviewer over the phone. The questionnaire comprised basic patient information and questions regarding the QoL. Results: There were 12 male participants and eight females. The total WHO-QoL BREF score of the participants is 94.15 ± 10.01 (out of 125). The differences between the mean scores of all domains according to participants’ demographic, distortion, and surgical variables were insignificant. Conclusion: Ensuring the QoL and function improvement after treatment of LLD is crucial. More attention must be paid to selecting the appropriate procedure for the suitable patient when treating LLD.

Guided Growth in Leg Length Discrepancy in Beckwith-Wiedemann Syndrome: A Consecutive Case Series.

Beckwith-Wiedemann Syndrome (BWS) is a rare genetic disorder characterized by overgrowth, macroglossia, abdominal wall defects, neonatal hypoglycemia, predisposition to embryonal tumor, lateralized overgrowth, and leg length discrepancy (LLD), which can affect normal posture and gait. Aim of this study was to evaluate the effects of guided growth (temporary epiphysiodesis technique) as LLD management in BWS patients. Between 2007 and 2021, 22 BWS patients (15 F, 7 M) with a mean age of 7.9 years (2.9–14.4) and a mean LLD at first surgery of 3.65 cm (2–10), underwent temporary proximal tibial (PTE) and distal femur epiphysiodesis (DFE). In 18 patients the first surgical procedure was PTE, in one, DFE, and in 3 cases, PTE and DFE at the same time, respectively. Eleven patients reached equality of leg length after a mean follow-up of 7.7 years (3.7–13.0) and mean age of 13.3 years (12.7–27.5); 10 patients underwent 3 surgical procedures, one 7 procedures. Fifteen patients had no complications. No severe complications, infection, articular stiffness, or neuro-vascular lesions occurred in remaining patients; complications included secondary varus or valgus axial deviation in a total of 6 patients, and two screw breakages in two patients. Guided growth as a minimally invasive procedure seems efficient for LLD treatment with low complication rate in BWS patients.

What Are the Potential Benefits and Risks of Using Magnetically Driven Antegrade Intramedullary Lengthening Nails for Femoral Lengthening to Treat Leg Length Discrepancy?

What Are the Potential Benefits and Risks of Using Magnetically Driven Antegrade Intramedullary Lengthening Nails for Femoral Lengthening to Treat Leg Length Discrepancy?

Ruptured External Iliac Arterial Aneurysm in a Patient Who Underwent Arteriovenous Fistula Procedure at Childhood for Treatment of Leg Length Discrepancy Caused by Poliomyelitis

Ruptured External Iliac Arterial Aneurysm in a Patient Who Underwent Arteriovenous Fistula Procedure at Childhood for Treatment of Leg Length Discrepancy Caused by Poliomyelitis

Percutaneous femoral shortening over a nail using on-site smashing osteotomy technique.

Closed femoral-shortening osteotomy over an intramedullary nail for the treatment of leg length discrepancy (LLD) is a demanding surgical technique, classically requiring specialized instrumentation (intramedullary saw and chisel). Herein, we describe our experience with shortening osteotomy over a nail, using a percutaneous multiple drill-hole osteotomy technique to perform the bone section with the osteotomized bone smashed and let on-site. We operated on six patients with LLD due to: hemihypertrophy syndrome (three patients), congenital short femur, hemiplegic cerebral palsy, and growth plate injury. Mean femoral shortening was 4.2cm. Osteotomy was performed via a multiple drill-hole technique, and femurs were stabilized using an intramedullary nail. Post-operative clinical and radiological data were recorded. Residual LLD was assessed through long-standing teleroentgenography. Shortening was achieved, with a final LLD of < 1cm in all patients. All patients were satisfied and considered the lengths of the lower limbs to be equal. Our technique did not require special surgical skill or specialized instrumentation. Moreover, we did not record intraoperative and post-operative complications. Percutaneous femoral-shortening osteotomy over a nail using the on-site smashing osteotomy technique was effective and safe in treating LLD in this initial case series.

Treatment of the moderate leg length discrepancy in children using temporary bilateral blocking of the growth plate with plates and screws: first experience

The results of applying of temporary bilateral blocking (TBB) of the growth plate (GP) for moderate leg length discrepancy (LLD) treatment showed sufficient efficacy and safety. It is known some studies are skeptical to use this method.Objective: to evaluate the results of moderate LLD treatment in children using TBB of the GP with plates and screws.Methods: 33 patients (14 boys and 19 girls) with moderate LLD were treated using TBB of the GP with non-blocking plates with screws: in 24 patients TBB of the distal femoral GP, in 2 patients — TBB of the proximal tibial GP and in 7 patients — combined TBB of both GP was performed. The mean age of patients was 10.7 ± 2.6 years. LLD before treatment ranged from 2 to 5.5 cm (mean — 2.9 ± 0.68). Evaluation of LLD after TBB of the GP was performed in dynamics every 6–12 months using clinical and radiological methods. For assessment of the secondary deformities formation during treatment, we measured mLDFA and MPTA angles and the mechanical axis zone (MAZ).Results: during the observation period, 25 patients have completed the treatment, 8 continued the treatment. Correction of the LLD of different values was noted in all patients (p &lt; 0.05). At the time of TBB completion and removing of fixators, the mean LLD was 0.75 ± 0.82 cm. A good treatment results were obtained in 14 children (77.8 %), of which 7 children achieved a complete correction (50 %), fair — in 3 children (16.7 %), poor — in 1 child (5.5 %). The difference between the mean values of mLDFA and MPTA before and after the treatment was considered statistically insignificant (p &gt; 0.05). Among the complications it should be noted moderate pain syndrome for 2 weeks — 2 cases (6 %), hemarthrosis — 1 case (3 %), contracture of the knee joint — 1 case (3 %), plate migration — 1 case (3 %), secondary angular deformation — 1 case (3 %).Conclusions: the TBB of the GP with plates and screws using for moderate LLD treatment is effective and safe method. The amount of complications that required surgical intervention was 6 %.

Asimetría de miembros inferiores: resultados posteriores a epifisiodesis definitiva en la adultez en un hospital pediátrico de alta complejidad

BackgroundThe most used surgical treatment in children with leg length discrepancy is permanent percutaneous epiphysiodesis. The purpose of this study is to describe the results at skeletal maturity, as well as the complications in children with leg length asymmetry treated with permanent epiphysiodesis, in a high complexity paediatric hospital since 1993, and to analyse the variables related to the percentage of correction. Materials and methodsDescriptive, retrospective study, including a review of clinical and radiological records. The study included all patients with a diagnosis of lower limb asymmetry, and who had permanent epiphysiodesis as only treatment, as well as an x-ray at skeletal maturity. A descriptive analysis and a regression analysis were performed between the percentage of correction and predictor variables, gender, aetiology, initial and predicted asymmetry, and at adulthood, method of prediction, and pubertal development. Complications were analysed. ResultsThe study included 29 patients, of which 16 were boys, and 21 were congenital. The median age at surgery was 12.1 (range: 10.8-13.6) and 13.7 (range: 11.4-15.2) years in females and males, respectively. Asymmetry at adulthood was less than 2 cm in 69% of cases. The range of the correction percentage was 2.6 to 106.5%, being associated negatively to the presence of advanced puberty (Coeff= -23.9; P=.025) and positively associated with Moseley (Coeff= 38.9; P=.056). The complications included angular deformity in zone 1 (10%). DiscussionPermanent percutaneous epiphysiodesis was an effective and safe tool for the treatment of leg length discrepancy in our patients. Emphasis is placed on the evaluation of pubertal development during follow-up in order to optimise results at adulthood. Level of evidenceIV.

Allongement de membre « automatique » par instrumentation intramédullaire : pièges et résultats préliminaires

BackgroundThe treatment of leg length discrepancy and deformities has become more common over the last few decades due to newly developed implants. Lengthening using fully implantable intramedullary nails provides many advantages; however, only little data is available. Therefore we aimed to determine: (1) safety of the implant, (2) the complication rate and (3) functional outcome after magnetic driven intramedullary bone lengthening with a telescopic implant. HypothesesAutomatic bone lengthening with intramedullary nails provide good short-term outcome. Patients and methodsTen patients with limb length discrepancy of lower extremity, treated with an Ellipse PRECICE® nail, were included in this retrospective follow-up study. The mean limb length discrepancy was 4.7cm (range: 2.5–7.0cm). ResultsIn all patients, limb-lengthening goals were reached within a range of ±0.5cm after a mean time of 53 days. However, in 2 patients, mechanical failures with unintended shortening were observed. In a further patient, nail breakage occurred. Overall, 7 patients presented with complications during the follow-up period. DiscussionThe PRECICE® nail represents a new, fully implantable, magnetically driven device for limb lengthening. However, due to a high rate of complications, a close follow-up is necessary to identify early implant failures and to avoid severe adverse outcomes. Level of evidenceRetrospective follow-up study, case series Level IV.

Pitfalls in automatic limb lengthening – First results with an intramedullary lengthening device

BackgroundThe treatment of leg length discrepancy and deformities has become more common over the last few decades due to newly developed implants. Lengthening using fully implantable intramedullary nails provides many advantages; however, only little data is available. Therefore, we aimed to determine: (1) safety of the implant, (2) the complication rate and (3) functional outcome after magnetic driven intramedullary bone lengthening with a telescopic implant. HypothesesAutomatic bone lengthening with intramedullary nails provide good short-term outcome. Patients and methodsTen patients with limb length discrepancy of lower extremity, treated with an Ellipse PRECICE® nail, were included in this retrospective follow-up study. The mean limb length discrepancy was 4.7cm (range: 2.5–7.0cm). ResultsIn all patients, limb lengthening goals were reached within a range of ±0.5cm after a mean time of 53 days. However, in 2 patients, mechanical failures with unintended shortening were observed. In a further patient nail breakage occurred. Overall, 7 patients presented with complications during the follow-up period. DiscussionThe PRECICE® nail represents a new, fully implantable, magnetically driven device for limb lengthening. However, due to a high rate of complications, a close follow-up is necessary to identify early implant failures and to avoid severe adverse outcomes. Level of evidenceRetrospective follow-up study, case series, level IV.

Intramedullary magnetically actuated limb lengthening in a patient with congenital humeral limb shortening

The treatment of leg length discrepancy has become a common procedure in orthopaedic surgery. However, lengthening of humeral deformities is still infrequent.The purpose of this case report was to present humeral lengthening with a new intramedullary lengthening device (PRECICE® P2 for tibia) in a 32 year old female patient with congenital shortening.Hereby the telescopic device presents a promising tool for humeral limb lengthening with excellent outcome at short-term in this case.

Leg length discrepancy treatment with subtrochanteric shortening osteotomy and blade plate fixation.

Subtrochanteric femoral shortening osteotomy is a method of surgical treatment of lower limb discrepancy (LLD). It is less commonly used due to numerous limitations and the resulting decrease in height, which is an undesirable effect for most patients. The aim of this study was to analyze the results and complications of treatment of leg length discrepancy (LLD) by femoral shortening osteotomy fixed with a blade plate and screws. The study group comprised 18 patients treated by subtrochanteric shortening osteotomy fixed with a blade or straight plate and screws. The age of patients at the time of the operation ranged from 12 years and two months to 24 years and 3 months (mean 17 years and 8 months). Before the operation, the mean LLD amounted to 4.1cm (from 2,5 to 7,0). The size of the same-time resection of the femur at the level of the subtrochanteric osteotomy ranged from 2.5 cm to 5.0 cm (mean 3.7). The follow-up period ranged from 6 months to 15 years and 9 months (mean 3 years and 6 months). The analysis of the results was based on the following criteria. A good result was defined as obtaining an equal length of both legs or achieving the intended amount of shortening. A fair result was defined as a post-operative LLD from 0.5 cm to 1 cm. A poor result comprised patients with post-operative LLD greater than 1 cm or with complications that leave a lasting impact or complications requiring revision surgery. A good result was obtained in 15 patients and a fair one in 3 patients. Complications appeared in 5 (28%) patients. The most common complication was delayed bone healing. Full weight -bearing of the operated limb was allowed between 12 and 32 weeks post-surgery (mean 19 weeks). The final LLD ranged from 0 cm to 3 cm (mean 0.6 cm). Equal limb length was obtained in 13 (72%) patients. 1. Subtrochanteric femoral shortening osteotomy fixed with a plate and screws, taking into consideration the limitation of possible correction to 5-6 cm, is an effective method of treatment of lower limb discrepancy with a relatively low complication rate. 2. The most common complications of subtrochanteric shortening osteotomy are disorders of bone union. 3. The use of lag screws for stabilisation of the osteotomy with an angle plate may reduce the risk of complications.

Diagnosis and treatment of leg-length discrepancy in scoliosis

Methods The x-rays (upright ap-view) of 250 patients diagnosed with “idiopathic scoliosis” were examined to determine a leg length difference of >1.0 cm. First issue: How many patients show scoliosis as a compensation mechanism of leg-length discrepancy? How many needed epiphysiodesis in differences >1.5cm. Second issue: What causes of leglength discrepancy are found and what are the therapeutic consequences? Patients with neurological findings were excluded.

Intramedullary Skeletal Kinetic Distractor in the Treatment of Leg Length Discrepancy—A Review of 16 Cases and Analysis of Complications

The intramedullary skeletal kinetic distractor (ISKD; Orthofix) is a relatively new device available for limb lengthening. This fully implantable mechanical nail promises reduced morbidity over traditional methods where external fixation is used. We report on our experience using this device in treating 16 patients with leg length discrepancy. Retrospective review of 16 consecutive patients treated with ISKD. Tertiary trauma hospital. Thirteen males and 3 females were treated with the ISKD between 2004 and 2009. There were 11 femora and 5 tibiae. The indication for lengthening was posttraumatic shortening in 15 patients and congenital hypoplasia in the remaining patient. Limb length gained, rate of lengthening, time to consolidation, complications, and factors that may be associated with complications. All patients in the series successfully completed treatment and reached the desired limb length with radiographic evidence of consolidation. The average leg length increase was 35 mm (21-75 mm). No infection, malunion, or joint contracture was observed. A length of less than 100 mm of the thick portion of the nail in the distal fragment is associated with the likelihood of a "runaway nail" (distraction index > 1.5 mm/d). Six patients had poor regenerate requiring bone grafting. Likelihood of poor regenerate was associated with number of previous operations on the lengthened bone. Three patients had nails that were difficult to distract and required closed manipulation under anesthesia. The ISKD is an effective method for correcting leg length discrepancies. Complications are frequent but are manageable with standard techniques. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator

The aim of this study was to evaluate the efficacy of tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator for the treatment of leg length discrepancy or short stature. This retrospective study was performed on 18 tibiae (13 patients) in which attempts were made to reduce complications. We used an Ilizarov external fixator and a nail (10 mm diameter in 17 tibiae and 11 mm in one tibia) in combination. Average limb lengthening was 4.19 cm (range, 2.5-5.5). The mean duration of external fixation was 12.58 days per centimetre gain in length, and the mean consolidation index was 40.53 (range, 35.45-51.85). All distracted segments healed spontaneously without refracture or malalignment. Gradual limb lengthening using a reamed type intramedullary nail and circular external fixation in combination was found to be reliable and effective and reduced external fixation time with fewer complications.

Treatment of leg length discrepancy with temporary epiphyseal stapling in children with juvenile idiopathic arthritis during 1957-99.

Temporary epiphyseal stapling is a flexible method for correction of leg length discrepancy. Due to a high risk of premature epiphyseal plate closure and other complications reported in previous studies, the technique has not been in wide use. In this study a retrospective analysis of 71 knees in patients with juvenile idiopathic arthritis was performed to determine the safety and effectiveness of the method. Only seven minor reversible complications were encountered, and the authors found the method suitable even for immunologically compromised patients.