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VOLUME 14 , ISSUE 3 ( September-December, 2019 ) > List of Articles

Original Article

Correction of Bowleg Deformity in Achondroplasia through Combined Bony Realignment and Lateral Collateral Ligament Tightening

Stanley Jones, Stephen N Giles

Keywords : Achondroplasia, Bowlegs, Genu varum, Ilizarov, Lateral collateral ligament

Citation Information : Jones S, Giles SN. Correction of Bowleg Deformity in Achondroplasia through Combined Bony Realignment and Lateral Collateral Ligament Tightening. 2019; 14 (3):132-138.

DOI: 10.5005/jp-journals-10080-1441

License: CC BY-NC-SA 4.0

Published Online: 03-09-2020

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Introduction: Achondroplasia is one of the most common osteochondrodysplasias with an incidence of 1 in 26,000 live births. Bowing of lower limbs can cause significant morbidity in this population. The use of the Ilizarov external fixator to tighten collateral ligaments of the knee in children has not been reported in the literature. We report the technique and early results of lateral collateral ligament (LCL) tightening with correction of genu varum in children with achondroplasia. Materials and methods: A retrospective review of children with achondroplasia presenting with bowleg deformity who were treated by corrective osteotomy and LCL tightening was conducted. Between 1998 and 2003, 12 patients (24 limb segments) underwent this procedure and were included in the study. All patients had grade III LCL laxity preoperatively. Pre- and postoperative anteroposterior standing mechanical axis radiographs were evaluated. The final outcome was graded using the grading system of Paley et al. Results: All patients had bilateral corrections. The Ilizarov external fixator was used in 10 patients and the Orthofix limb reconstruction system in 2 patients. The bony realignment was achieved through monofocal or bifocal tibial osteotomies. The LCL was tightened in all limb segments using the Paley's type II strategy. The final result was graded as excellent in 20 limb segments and good in 4 limb segments. One patient developed transient common peroneal nerve palsy, four developed grade II pin site infections, and there was premature consolidation of the tibial regenerate in one patient.


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  1. Shapiro F. Skeletal dysplasias. In: Paediatric lower limb deformities 2001. pp. 733–871.
  2. Ponseti IV. Skeletal growth in achondroplasia. J Bone Joint Surg 1970;52-A(4):70. DOI: 10.2106/00004623-197052040-00004.
  3. Kopits SE. Orthopaedic complications of dwarfism. Clin Orthop 1976;114(114):153–179.
  4. Kopits SE. Genetics clinics of the John Hopkins hospital. surgical intervention in achondroplasia. Correction of bowleg deformity in achondroplasia. Johns Hopkins Med J 1980;146(5):206–209.
  5. Bailey JA. Orthopaedic aspects of achondroplasia. J Bone Joint Surg 1970;52-A(7):1285–1301. DOI: 10.2106/00004623-197052070-00001.
  6. Hunter AG, Bankier A, Rogers JG, et al. Medical complications of achondroplasia: a multicentre patient review. J Med Genet 1998;35(9):705–712. DOI: 10.1136/jmg.35.9.705.
  7. Stanley G, McLoughlin S, Beals RK. Observations on the cause of bowlegs in achondroplasia. J Pediat Orthopaed 2002;22(1):112–116. DOI: 10.1097/01241398-200201000-00023.
  8. Haga N. Management of disabilities associated with achondroplasia. J Orthop Sci 2004;9(1):103–107. DOI: 10.1007/s00776-003-0729-4.
  9. Yasui N, Kawabata H, Kojimoto H, et al. Lengthening of the lower limbs in patients with achondroplasia and hypochondroplasia. Clin Orthop 1997;344(344):298–306. DOI: 10.1097/00003086-199711000-00030.
  10. Saleh M, Burton M. Leg lengthening: patient selection and management in achondroplasia. Orthopedic Clinics of North America 1991;22(4):589–599.
  11. Laurencin CT, Ferriter PJ, Mills MB. Oblique proximal tibial osteotomy for the correction of tibia vara in the young. Clin Orthop Rel Res 1996;327:218–224. DOI: 10.1097/00003086-199606000-00027.
  12. Paley D, Bhatnagar J, Herzenberg JE, et al. New procedures for tightening knee collateral ligaments in conjunction with knee realignment osteotomy. Orthopedic Clinics of North America 1994;25(3):533–555.
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