Kniegelenksnahe Wachstumsmodulation durch Hemiepiphysiodese

Vogt, B; Frommer, Adrien; Gosheger, Georg; Toporowski, Gregor; Tretow, Henning; Rödl, Robert; Laufer, Andrea

doi:10.1007/s00132-021-04122-8

Cited by 4 publications

(6 citation statements)

References 39 publications

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“…Coronal deformities originating both at the femur and tibia may require an additional correction osteotomy of the tibia [19]. However, in skeletally immature patients, extensive osteotomies can often be avoided by guided growth through temporary HED [21,23]. The realignment of coronal angular deformities may facilitate the use of intramedullary lengthening nails, rather than performing lengthening and deformity correction with an external fixator [38].…”

Section: Discussionmentioning

confidence: 99%

“…After HED, deformity rebound may, in particular, occur in cases of implant removal before physeal closure. Even though serial guided growth procedures can be employed for the treatment of residual or recurring malalignment, as long as sufficient growth potential remains, temporary HED should, if feasible, be conducted near skeletal maturity to reduce the risk of persistent limb malalignment [7,21,23].…”

Section: Discussionmentioning

confidence: 99%

“…Of four patients with varus malalignment, two patients had the staples inserted at the distal lateral femur and two at the proximal lateral tibia, respectively. The implantation was performed according to the manufacturer's instructions as previously described [21,23,28].…”

Section: Guided Growthmentioning

confidence: 99%

“…Combined acute femoral correction osteotomy and subsequent femoral lengthening for the treatment of LLD and coexistent angular deformities reportedly achieves satisfactory results in adults [18,19]. In skeletally immature patients, on the other hand, the realignment of valgus or varus deformities can be achieved by hemiepiphysiodesis (HED) [20,21]. Even though temporary HED close to the knee and femoral distraction osteogenesis using antegrade intramedullary lengthening nails are well-established and widely applied procedures-either in combination or as a standalone treatment-to our knowledge, no studies to date have evaluated their combined application in skeletally immature patients.…”

Section: Introductionmentioning

confidence: 99%

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Antegrade Intramedullary Femoral Lengthening and Distal Temporary Hemiepiphysiodesis for Combined Correction of Leg Length Discrepancy and Coronal Angular Deformity in Skeletally Immature Patients

Laufer

Frommer

Gosheger

et al. 2023

JCM

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Leg length discrepancies (LLD) are frequently associated with coronal malalignment. Temporary hemiepiphysiodesis (HED) is a well-established procedure for the correction of limb malalignment in skeletally immature patients. For treatment of LLD > 2 cm, lengthening with intramedullary devices gains increasing popularity. However, no studies have investigated the combined application of HED and intramedullary lengthening in skeletally immature patients. This retrospective single-center study evaluated the clinical and radiological outcomes of femoral lengthening with an antegrade intramedullary lengthening nail combined with temporary HED performed in 25 patients (14 females) between 2014 and 2019. Temporary HED through the implantation of flexible staples of the distal femur and/or proximal tibia was either performed prior (n = 11), simultaneously (n = 10) or subsequently (n = 4) to femoral lengthening. The mean follow-up period was 3.7 years (±1.4). The median initial LLD was 39.0 mm (35.0–45.0). Twenty-one patients (84%) presented valgus and four (16%) showed varus malalignment. Leg length equalization was achieved in 13 of the skeletally mature patients (62%). The median LLD of the eight patients with residual LLD > 10 mm at skeletal maturity was 15.5 mm (12.8–21.8). Limb realignment was observed in nine of seventeen skeletally mature patients (53%) in the valgus group, and in one of four patients (25%) in the varus group. Combining antegrade femoral lengthening and temporary HED is a viable option to correct LLD and coronal limb malalignment in skeletally immature patients; however, achieving limb length equalization and realignment may be difficult in cases of severe LLD and angular deformity, in particular.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Guided Growthmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Antegrade Intramedullary Femoral Lengthening and Distal Temporary Hemiepiphysiodesis for Combined Correction of Leg Length Discrepancy and Coronal Angular Deformity in Skeletally Immature Patients

Laufer

Frommer

Gosheger

et al. 2023

JCM

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“…For correction of LLD, permanent or temporary operation techniques are commonly employed [1,2,[7][8][9]. For gradual correction of angular deformities of the lower limb in skeletally immature patients, temporary hemi-epiphysiodesis is the preferred surgical treatment [4][5][6]10]. Several previous studies have shown that epiphysiodesis is a reliable approach with few complications [1,4,6,11,12].…”

mentioning

confidence: 99%

Radiographic reference values of the central knee anatomy in 8–16-year-old children

Vogt

Hvidberg

Rölfing

et al. 2023

ActaO

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Background and purpose: For correction of leg-length discrepancy or angular deformity of the lower limb in skeletally immature patients temporary or permanent (hemi-)epiphysiodesis can be employed. These are reliable treatments with few complications. Recently, radiographic analysis of treatment-related alterations of the central knee anatomy gained interest among pediatric orthopedic surgeons. To date the comparison and adequate interpretation of potential changes of the central knee anatomy is limited due to the lack of defined standardized radiographic references. We aimed to establish new reference values of the central knee anatomy.Patients and methods: A retrospective analysis of calibrated longstanding anteroposterior radiographs of 254 skeletally immature patients with a chronological age ranging from 8 to 16 years was conducted. The following radiographic parameters were assessed: (1) femoral floor angle, (2) tibial roof angle, (3) width at femoral physis, and (4) femoral notch–intercondylar distance.Results: All observed radiographic parameters were normally distributed with a mean age of 12.4 years (standard deviation [SD] 2, 95% confidence interval [CI] 12.2–12.6). Mean femoral floor angle was 142° (SD 6, CI 141.8–142.9), mean tibial roof angle was 144° (SD 5, CI 143.7–144.1), mean width at femoral physis was 73 mm (SD 6, CI 72.8–73.9), and mean femoral notch–intercondylar distance was 8 mm (SD 1, CI 7.5–7.7). The estimated intraclass correlation coefficient values were excellent for all measurements.Conclusion: This study provides new radiographic reference values of the central knee anatomy for children between 8 and 16 years and we suggest considering values within the range of 2 SD as the physiological range.

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