Strategies in Trauma and Limb Reconstruction

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VOLUME 16 , ISSUE 3 ( September-December, 2021 ) > List of Articles

TECHNICAL ARTICLE

Guided Growth for Tibial Recurvatum

Peter M. Stevens, Andrew Stephens, David Rothberg

Keywords : Genu recurvatum, Guided growth, Tibial recurvatum

Citation Information : Stevens PM, Stephens A, Rothberg D. Guided Growth for Tibial Recurvatum. 2021; 16 (3):172-175.

DOI: 10.5005/jp-journals-10080-1535

License: CC BY-NC-SA 4.0

Published Online: 15-01-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Aim and objective: Sagittal guided growth of the distal anterior femur has been shown to be effective for the correction of fixed knee flexion deformity that is encountered in clinical practice. The opposite deformity, namely genu recurvatum, is comparatively uncommon in children. The most common aetiology is post-traumatic. Acute correction by means of osteotomy has significant associated risks. Our objective was to determine whether a posterior 8-plate would suffice in correcting tibial recurvatum and obviate the need for an osteotomy. Materials and methods: We included a total of five deformities, three boys (one bilateral) and one girl, managed by means of tethering of the posterior proximal tibial physis with a tension band plate. Standard radiographs obtained preoperatively and at follow-up included a standing anteroposterior (AP) of the legs noting limb lengths and the mechanical axis. We also obtained standing lateral views of each knee in maximal extension to measure and compare the posterior proximal tibial angle (PPTA). Results: The same-day surgery was well tolerated and there were no surgical or post-operative complications. The preoperative PPTA ranged from 106° to 117° and averaged 84° at follow-up. Correction occurred in an average of 20 months (range of 18–24 months). The patient with bilateral recurvatum due to Hurler\'s syndrome developed unilateral recurrent recurvatum culminating in percutaneous reinsertion of the metaphyseal screw. For each patient, knee hyperextension and associated pseudo-laxity resolved and limb lengths remained equal at follow-up. Conclusion: Children with progressive genu recurvatum typically present with an insidious onset of symptoms. Guided growth of the posterior proximal tibia is a safe and effective means of correcting the deformity; osteotomy was avoided in this series. Level of evidence: III – retrospective case series – no controls.


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  1. Stevens PM. Guided growth for angular correction: a preliminary series using a tension band plate. J Pediatr Orthop 2007;27(3): 253–259. DOI: 10.1097/BPO.0b013e31803433a1.
  2. Kramer A, Stevens P. Anterior Femoral Stapling. J Pediatric Orthopedic 2001;21(6):804–807.
  3. Heflin J, Ford S, Stevens P. Guided growth for tibia vara (Blount's Disease). Medicine 2016;95(41):e4951. DOI: 10.1097/MD.00000000 00004951.
  4. Morin M, Klatt, J, Stevens PM. Cozen's deformity: resolved by guided growth. Strategies Trauma Limb Reconstr 2018;13(2):87–93. DOI: 10.1007/s11751-018-0309-y.
  5. Stevens P, Pease F. Hemiepiphysiodesis for post-traumatic tibial valgus. J Pediatr Orthop 2006;26(3):385–392. DOI: 10.1097/01.bpo.0000206515.84577.70.
  6. Welborn MC, Stevens PM. Correction of angular deformities due to focal fibrocartilaginous dysplasia using guided growth: a preliminary report. J Pediatr Orthop 2017;37(3):e183–e187. DOI: 10.1097/BPO.0000000000000785.
  7. Journeau P. Update on guided growth concepts around the knee in children. Orthop Traumatol Surg Res 2019;106(1S):S171–S180. DOI: 10.1016/j.otsr.2019.04.025.
  8. Kramer A, Stevens PM. Anterior femoral stapling. J Pediatr Orthop 2001;21(6):804–807. PMID: 11675559.
  9. Klatt J, Stevens PM. Guided growth for fixed knee flexion deformity. J Pediatr Orthop 2008;28:626–631. DOI: 10.1097/BPO.0b013e318183d573.
  10. Paley D. Principles of deformity correction. Springer, Berlin, Heidelberg; 2002.
  11. Burks R, Schaeffer J. A simplified approach to the tibial attachment of the posterior cruciate ligament. Clin Orthop Relat Res 1990;254: 216–219. PMID: 2323134.
  12. Mycoskie P. Complications of osteotomies about the knee in children. Orthopedics 1981;4(9):1005–1015. DOI: 10.3928/0147-7447-19810 901-04.
  13. Beslikas T, Christodoulou A, Chytas A, et al. Genu recurvatum deformity in a child due to Salter Harris type V fracture of the proximal tibial physis treated with high tibial dome osteotomy. Case Rep Orthop 2012;2012:219231. DOI: 10.1155/2012/219231.
  14. Kim T, Lee S, Yoon J, et al. Proximal tibial anterior opening-wedge oblique osteotomy: a novel technique to correct recurvatum. Knee 2014;24(2):345–353. DOI: 10.1016/j.knee.2016.10.008.
  15. Choi I, Chung C, Cho T, et al. Correction of genu recurvatum by the Ilizarov method. J Bone Joint Surg (Br) 1999;81(5):769–774. DOI: 10.1302/0301-620x.81b5.9589.
  16. Manohar B, Fassier F, Rendon J, et al. Correction of proximal tibial recurvatum using the Ilizarov technique. J Pediatr Orthop 2012;32(1):35–41. DOI: 10.1097/BPO.0b013e31823b15e2.
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