Partial percutaneous epiphyseodesis in patients with congenital abnormalities of the growth plates.

Abstract

We present a rare series of a small cohort of seven patients with 12 valgus knees. This is the largest series of children with underlying growth plate disorders published so far. Prediction of remaining growth in these children is difficult as most existing methods of growth prediction focus on normal patients. These methods of growth prediction in otherwise normal children are only 86-94% accurate at best. Hence we chose to use an educated guess based on the method by Menelaus to predict the right timing for surgery in our patients. Partial percutaneous epiphyseodesis has been shown to be an effective and minimally invasive method in the treatment of angular deformities of the knee. The successful partial ablation of the physes through a percutaneous approach was achieved in all of our patients. However, due to difficulties in the accurate assessment of remaining growth the results were not ideal. The mean preoperative deformity was 23 degrees of valgus and an average correction of 18 degress was achieved. Five patients with five knees (41.6%) had overcorrection or undercorrection of 10 degrees or more. Four of them required further surgical intervention. Difficulty arose mainly with the correct prediction of growth arrest in patients with abnormal physes. We review and discuss the current literature on partial epiphyseodesis and methods for the prediction of remaining growth.