Do we need to do overcorrection in Blount’s disease?

Abstract

Purpose In order to prevent recurrent deformity, overcorrection in Blount's disease has been a common practice by most paediatric orthopaedic surgeons. However, some patients have persistent valgus alignment resulting in awkward deformity. The femoro-tibial angle (FTA) was measured in this series of cases to determine the necessity of such practice. Method During 1998-2010, patients with Blount's disease stage 2 by Langenskiold, aged from 30 to 40 months who had failed from bracing and underwent valgus osteotomy were included. Seventeen legs had postoperative FTA 7-13°(group 1) and 48 legs had postoperative FTA more than 13°(group 2). ROC curve was used to determine the appropriate FTA that was suitable to prevent recurrence. Results Four legs had recurrence (28.6 %) in group 1 and six legs (12.5 %) had recurrence in group 2. Chi-square test between two groups were not statistically significant in recurrence (p = 0.434). Age and BMI were not statistically significant between recurrent and non-recurrent groups. The ROC curve shows that overcorrection more than 15°did not show benefit to prevent the recurrence in Blount's stage 2. Conclusion Our study showed that the overcorrection group had non-statistically significant recurrence compared to the non-overcorrection group, and overcorrection more than valgus 15°has no benefit to prevent recurrence.

Medial Metaphyseal Slope as a Predictor of Recurrence in Blount Disease

“…Currently, the recommendation for progressive infantile Blount's disease is a proximal tibial osteotomy. Recurrence of Blount's disease is diagnosed when the FTA is more than 10° varus at follow‐up. Preoperative femorotibial angle (FTA) of greater than 10° of varus creates force on the medial side of the knee joint and probably predisposes the patient to medial proximal tibial physeal growth retardation.…”

“…Schoenecker et al ., and Ferriter and Shapiro note a varying frequency of recurrence of varus deformity after initial surgery and suggest that surgical correction should be performed at an early age. Following corrective osteotomy in children at more than 3 years of age with stage 3 Langenskiold, there is a high rate of recurrence. However, performing corrective osteotomy in patients younger than 3 years of age with stage 2 Langenskiold is associated with 10% recurrence.…”

“…Following corrective osteotomy in children at more than 3 years of age with stage 3 Langenskiold, there is a high rate of recurrence. However, performing corrective osteotomy in patients younger than 3 years of age with stage 2 Langenskiold is associated with 10% recurrence. Recurrent deformity in patients younger than 3 years of age with stage 2 Langenskiold may result from multiple factors, such as increasing obesity, age, and staging.…”

What’s New in Limb Lengthening and Deformity Correction

“…Acute deformity correction can be used in selected cases 16 . Overcorrection into valgus is not typically needed in younger children with Blount disease 17 . In patients treated with gradual correction using circular fixation, equivalent results were reported with or without fibular osteotomy 18 .…”

Treatment of Patients With Early Stages of Infantile Blount`s Disease

“…Общепринятой для инфантильной формы болезни Блаунта является классификация, предложенная в 1952 г. Langenskiöld [15,16] [5,15,22]. При этом вопрос конкретной величины (по данным литературы, значения варьируют от 3 о до 20 о [7]), ее влиянии на частоту рецидивов и как таковой необходимости в гиперкоррекции остается предметом дискуссий [20]. [18].…”