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VOLUME 17 , ISSUE 1 ( January-April, 2022 ) > List of Articles

Original Article

Tension-band Plating for Leg-length Discrepancy Correction

Jaap J Tolk, Rajiv Merchant, Peter R Calder, Aresh Hashemi-Nejad, Deborah M Eastwood

Keywords : Epiphysiodesis, Guided growth, Leg-length discrepancy, Tension-band plating

Citation Information : Tolk JJ, Merchant R, Calder PR, Hashemi-Nejad A, Eastwood DM. Tension-band Plating for Leg-length Discrepancy Correction. 2022; 17 (1):19-25.

DOI: 10.5005/jp-journals-10080-1547

License: CC BY-NC-SA 4.0

Published Online: 24-05-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Aim: Dual tension-band plates are used for temporary epiphysiodesis and longitudinal guided growth. The study aim was to assess rate of correction, to identify development of femoral and tibial intra-articular deformity during correction and to document resumption of growth after plate removal. Materials and methods: A retrospective study of 34 consecutive patients treated with dual tension-band plates between 2012 and 2020 was performed. Twenty-four patients had surgery at the distal femur, six at the proximal tibia and four at both. Twenty-five female patients were treated at a mean age of 11.6 (±1.4) years and nine male patients at 13.5 (±1.5) years. Measurements were performed on standardised long-leg radiographs and included leg-length discrepancy (LLD), joint line congruency angle (JLCA), tibial roof angle, femoral floor angle and notch-intercondylar distance. Measurements were taken pre-operatively, at the end of discrepancy correction and at skeletal maturity. Results: The LLD reduced by a mean of 12.9 mm (95% CI 10.2–15.5) with the mean residual difference 8.4 mm (95% CI 5.4–11.4). The mean correction rate for the proximal tibia was 0.40 (SD 0.33) mm/month and 0.68 (SD 0.36) mm/month for the distal femur. A significant mean change in residual LLD [−2.5 mm (95% CI −4.2 to −0.7)] was observed between plate removal and skeletal maturity at the femoral level only. After length discrepancy correction, the tibial roof angle showed a significant difference of 8.4° (95% CI 13.4–3.4) between legs. In femoral epiphysiodesis patients, no important differences were observed. Conclusion: A significant reduction in LLD can be achieved using dual tension-band plating. A change in intra-articular morphology was observed only in the proximal tibia and not in the distal femur. In the authors’ opinion, tension-band plating is a useful tool for leg-length equalisation but should be reserved for younger patients or when residual growth is difficult to predict. It is one of the management strategies for limb-length difference prior to skeletal maturity.

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