Growth Modulation in Achondroplasia

McClure, Philip K.; Kılınç, Eray; Birch, John G.

doi:10.1097/bpo.0000000000001045

Cited by 20 publications

(21 citation statements)

References 14 publications

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“…Nonetheless, impressive outcomes have been demonstrated (P. Stevens, personal communication 2015). Limited published data regarding its use in those with achondroplasia [294] suggest that at least partial correction of malalignment can be accomplished. There even is anecdotal evidence that correction in one plane (varus deformity) will secondarily results in improvement of the other components (internal torsion and lateral instability) (P. Stevens, personal communication 2015).…”

Section: Natural History and Managementmentioning

confidence: 99%

Achondroplasia: a comprehensive clinical review

Pauli¹

2019

Orphanet J Rare Dis

307

374

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Achondroplasia is the most common of the skeletal dysplasias that result in marked short stature (dwarfism). Although its clinical and radiologic phenotype has been described for more than 50 years, there is still a great deal to be learned about the medical issues that arise secondary to this diagnosis, the manner in which these are best diagnosed and addressed, and whether preventive strategies can ameliorate the problems that can compromise the health and well being of affected individuals. This review provides both an updated discussion of the care needs of those with achondroplasia and an exploration of the limits of evidence that is available regarding care recommendations, controversies that are currently present, and the many areas of ignorance that remain.

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Section: Natural History and Managementmentioning

confidence: 99%

Achondroplasia: a comprehensive clinical review

Pauli¹

2019

Orphanet J Rare Dis

307

374

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“…Several reports of smaller series of patients with different conditions have been published. McClure et al 53 reported four patients with achondroplasia and genu varus with bilateral distal femoral and proximal tibial growth modulation in three of them and only tibial correction in the remaining. All limbs had some improvement of alignment; however, one patient went on to bilateral osteotomies.…”

Section: Correction Of Angular Deformitiesmentioning

confidence: 99%

Growth modulation with tension-band plates for the correction of paediatric lower limb angular deformity: current concepts and indications for a rational use

2021

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Growth modulation (GM) with tension-band plates (TBPs) by tethering part of the growth plate is an established technique for the correction of angular deformities in children, and it has increasingly supplanted more invasive osteotomies. Growth modulation with TBPs is a safe and effective method to correct a variety of deformities in skeletally immature patients with idiopathic and pathological physes. The most common indication is a persistent deformity in the coronal plane of the knee exceeding 10°, with anterior and/or lateral joint pain, patellofemoral instability, gait disturbance, or cosmetic concerns. GM has also shown good results in patients with fixed flexion deformity of the knee and ankle valgus. This paper reviews the history of the procedure, current indications, and recent advances underlying physeal manipulation with TBPs. Cite this article: EFORT Open Rev 2021;6:658-668. DOI: 10.1302/2058-5241.6.200098

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“…The consideration, however, of remaining growth from the instrumented physis is an important consideration in the setting of short stature conditions. McClure et al 20 reported on growth modulation about the knee to correct genu varum in 4 patients with achondroplasia and noted only 1 limb corrected to a neutral axis alone with the implantation performed at 5 years of age. In a larger series of skeletal dysplasia patients undergoing hemiepiphysiodesis, Yilmaz et al 21 found absence of sufficient remaining growth to be a reason for lack of benefit in a subset of their patients as well.…”

Section: Discussionmentioning

confidence: 99%

“…Lower extremity deformity correction by guided growth has also been reported in metabolic bone conditions such as renal osteodystrophy, nutritional rickets, and Morquio-Brailsford syndrome 16–18. Guided growth has also been reported in the setting of various skeletal dysplasias19–21 and as a case report in the setting of OI 22. To date, to our knowledge, there is no report of a series of deformity correction by growth modulation in the setting of OI.…”

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confidence: 98%

Multicenter Series of Deformity Correction Using Guided Growth in the Setting of Osteogenesis Imperfecta

Franzone

Wallace

Rogers

et al. 2022

Journal of Pediatric Orthopaedics

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Background: The mainstay of deformity correction and fracture prevention for patients with osteogenesis imperfecta (OI) includes osteotomies and intramedullary rodding. Guided growth, described in the setting of skeletal dysplasias, offers a less invasive means of deformity correction. We report a multicenter case series of guided growth procedures in the setting of OI. Methods: We retrospectively reviewed patients with OI at three institutions from April 2012 to April 2019: 18 patients underwent guided growth for angular deformity correction with minimum 1-year follow-up or full deformity correction and removal of guided growth hardware. Clinical characteristics, deformity measurements, and complications were collected. Distal femoral and proximal tibial hemiepiphysiodesis was performed using figure-of-eight plates and screws, and distal tibial medial hemiepiphysiodesis with cannulated screws. Preoperative and postoperative lateral distal femoral angle, medial proximal tibial angle, and lateral distal tibial angle were measured. Frequency and descriptive statistics were completed. Results: Eighteen patients with OI (five-I, four-III, six-IV, three-V) underwent 33 guided growth procedures with mean follow-up of 3.09 years; all received routine bisphosphonate treatment. Preoperative and postoperative mean joint angles were measured. The location for hemiepiphysiodesis included 8 distal femoral medial, 2 distal femoral lateral, 8 proximal tibial medial, 3 proximal tibial lateral, and 12 distal tibial medial. Twelve of the 33 procedures were in patients who had an intramedullary rod; 1 demonstrated backout of the epiphyseal and metaphyseal screws of a distal femoral medial figure-of-eight plate. It was revised to a larger plate with longer screws and removed upon completion of deformity correction. Conclusion: Guided growth may be used as an effective means of angular deformity correction with dysplastic OI bone. Having an intramedullary rod did not preclude the use of a guided growth technique. One procedure demonstrated screw backout. Given the short stature associated with OI, performing a guided growth procedure at an early enough age to allow time for correction should be considered. Level of Evidence: Level IV-case series.

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Growth Modulation in Achondroplasia

Abstract: Growth modulation is an effective means for deformity correction in the setting of achondroplasia. However implantation may need to be done earlier than would be typical for patients without achondroplasia. Osteotomy may still be required after growth modulation for incomplete correction.

Cited by 20 publications

References 14 publications

Achondroplasia: a comprehensive clinical review

Achondroplasia: a comprehensive clinical review

Growth modulation with tension-band plates for the correction of paediatric lower limb angular deformity: current concepts and indications for a rational use

Multicenter Series of Deformity Correction Using Guided Growth in the Setting of Osteogenesis Imperfecta

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