Prediction of loss of correction after hemiepiphysiodesis for the alignment of lower limb angular deformities

Schagemann, Jan C.; Kudernatsch, Nils; Russlies, Martin; Mittelstädt, Hagen; Götze, Melanie; Horter, Melanie; Paech, Andreas; Behnke, Barbara

doi:10.1097/md.0000000000028626

Cited by 5 publications

(3 citation statements)

References 22 publications

(60 reference statements)

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“…Concerning the impact of sex on rebound growth, the literature is ambiguous; Ramazanov et al 10 and Schagemann et al 30 found no influence on the risk of rebound, while we identified a higher risk for males. This might be due to the different definitions of the rebound.…”

Section: Discussioncontrasting

confidence: 56%

“…IGF1 is linked to the growth hormone (GH), which together with sex hormones is responsible for the growth spurt during puberty. 29 Concerning the impact of sex on rebound growth, the literature is ambiguous; Ramazanov et al 10 and Schagemann et al 30 found no influence on the risk of rebound, while we identified a higher risk for males. This might be due to the different definitions of the rebound.…”

Section: Discussionmentioning

confidence: 48%

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Isolating factors for the prediction of rebound after guided growth with tension band plating for the valgus deformity of the knee

Eberle,

Stephan,

Tedeus

et al. 2023

Journal of Children's Orthopaedics

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Purpose: The conditions leading to growth rebound after hemiepiphysiodesis are still poorly understood. This article analyzes the radiographical outcomes after guided growth with tension band plating, using plates in idiopathic genu valgum patients and attempts to generate a predictive model of growth rebound. Methods: Patients with idiopathic genu valgum deformity who received tension band plating were selected for evaluation. We only analyzed coronal plane deformities. Only patients with a long-standing X-ray before tension band plating surgery, a long-standing X-ray at tension band plating removal, and a long-standing X-ray at the latest follow-up after tension band plating removal were considered for this study. The change of mechanical axis deviation between the tension band plating removal and the last follow-up was evaluated for rebound, and ordinal logistic regression was performed to determine the relevant variables for predictive modeling rebound growth. Results: Overall, 100 patients (189 legs) were analyzed. The mean mechanical axis deviation at tension band plating removal was 8.4 mm in varus direction, and the mean mechanical axis deviation at the last follow-up was −3.4 mm (p ≤ 0.001). However, 111 legs (59%) showed rebound growth, 57 (30%) stayed stable, and 21 (11%) showed a continuous correction. Six significant factors significantly influencing rebound were isolated which are clinically relevant: sex, age, baseline mechanical axis deviation, mechanical lateral distal femoral angle, and mechanical medial proximal tibial angle, and mechanical axis deviation correction rate. Mechanical axis deviation correction rate had the highest odds ratios. The machine learning classification model for predicting rebound growth built from the study data showed a misclassification rate of 39%. Conclusion: There was a high rate of rebound growth in this cohort, especially for patients at a young age at implantation. The highest risk factors for rebound growth were male sex, and high correction rates, such as found during peak growth spurt. The proposed classification model needs more data to improve its predictive power before it can be used in clinics. Level of evidence: Level III.

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 48%

Isolating factors for the prediction of rebound after guided growth with tension band plating for the valgus deformity of the knee

Eberle,

Stephan,

Tedeus

et al. 2023

Journal of Children's Orthopaedics

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“…The rebound is associated with rapid correction rates, younger children, more severe deformities (>20°), or in patients with at least 1 year of growth [5,77,78,79 ▪▪ ,80 ▪ –82 ▪ ]. A higher BMI may have a protective effect against a rebound [77].…”

Section: The Rebound Phenomenonmentioning

confidence: 99%

Growth modulation for angular knee deformities: a practical guideline

Braga

Santili

Rodrigues

et al. 2022

Current Opinion in Pediatrics

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Purpose of reviewThis study aimed to review the established concepts and advances related to growth modulation for treating knee angular deformities. Although they are considered well tolerated procedures, careful indications and accurate techniques are necessary to ensure good results.Recent findingsIn addition to general clinical and radiographic evaluations, new tools such as two-dimensional low-dose radiography and gait analysis have been used to clarify angular and torsional combinations and the impact of mild angulations on the knee joint. Temporary epiphysiodesis is commonly the choice, and it can be performed with different implants such as staples, tension band plates (TBP), percutaneous transphyseal screws (PETS), sutures, and screws.SummaryConsidering its principles, TBP has been preferred for younger children. Cost can be a limitation, and research for alternative implants such as screws and nonabsorbable sutures indicate they might be an alternative in the future. In adolescents, PETS becomes an attractive alternative; however, its reversible character has been controversial, and further studies are needed to establish limits in younger patients.

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Correlation of Lower Limb Alignment with Mensical Meniscal Extrusion in Knee Osteoarthritis

da-hui,

shou-kang,

yang

et al. 2024

Preprint

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[Objective] This study aims to explore the relationship between Lower limb alignment parameters and the degree of Meniscal Medial Extrusion (MME) in patients with Knee Osteoarthritis (KOA), in hopes of providing new reference data for the prevention and treatment of KOA. [Methods] A retrospective study design was employed, analyzing 623 KOA patients treated at our hospital from 2022 to 2023, with 307 patients' information collected according to inclusion and exclusion criteria. Patients were divided into mild and severe groups based on the degree of MME, and differences in Lower limb alignment parameters between the two groups were compared, including AMA, JLCA, mLDFA, MPTA, FKJL, FTA, and mHKA. Univariate analysis, Pearson correlation analysis, and multivariate stepwise regression analysis were used, along with ROC curve assessment to evaluate the predictive value of Lower limb alignment parameters on the degree of MME. [Results] Univariate analysis showed significant correlations between AMA, JLCA, mLDFA, MPTA, and the degree of MME (P < 0.05). Pearson correlation analysis further confirmed the positive correlations between these parameters and the degree of MME. Multivariate stepwise regression analysis indicated that AMA, JLCA, and mLDFA are significant independent predictors of the severity of MME. ROC analysis suggested that the combination of AMA, JLCA, and mLDFA could better predict severe MME. When the values of AMA, JLCA, and mLDFA exceed 6.33°, 3.55°, and 86.34°, respectively, MME ≥ 0.3cm, significantly increasing the risk of MME. [Conclusion] AMA, JLCA, and mLDFA are closely related to the degree of MME in KOA patients and can serve as important parameters for assessing the severity of MME, holding significant implications for the early prevention and treatment of KOA.

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Prediction of loss of correction after hemiepiphysiodesis for the alignment of lower limb angular deformities

Cited by 5 publications

References 22 publications

Isolating factors for the prediction of rebound after guided growth with tension band plating for the valgus deformity of the knee

Isolating factors for the prediction of rebound after guided growth with tension band plating for the valgus deformity of the knee

Growth modulation for angular knee deformities: a practical guideline

Correlation of Lower Limb Alignment with Mensical Meniscal Extrusion in Knee Osteoarthritis

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