Systematic Review of the Effectiveness of Transphyseal Screws for Correction of Coronal Plane Knee Deformities and Meta-analysis of Comparative Studies With Tension Band Plates.

Abstract

Coronal-plane knee deformities, both genu varum and genu valgum, are common in pediatric orthopaedics and can be effectively managed in skeletally immature patients with guided growth techniques. Among these, percutaneous epiphysiodesis using transphyseal screws (PETS) and tension band plates (TBP) are widely used, yet their comparative effectiveness remains debated. A comprehensive search of PubMed, Embase, and Web of Science (January 2004 to January 2025) identified 603 studies. After applying the inclusion criteria, 13 studies (8 noncomparative and 5 comparative) were included in the analysis. Risk of bias was assessed using the ROBINS-I tool, and study quality was evaluated using the MINORS criteria. A frequentist random-effects meta-analysis was conducted to compare correction rates of mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), and mechanical axis deviation (MAD). PETS was effective, with correction rates for mLDFA, MPTA, and MAD ranging from 0.64 to 1.3 ​degrees/month, 0.52 to 0.86 degrees/month, and 1.3 to 3 mm/month, respectively. The meta-analysis showed faster correction with PETS compared to TBP: mLDFA (θ=0.71; P=0.05), MPTA (θ=0.60; P=0.06), and MAD (θ=0.80; P=0.11), although statistical significance was not reached. A meta-analysis of correction speed of mLDFA (θ=0.43; P=0.17) and MPTA (θ=0.6; P=0.06) in idiopathic patients did not show a significant difference, although faster correction with PETS was again observed. PETS is a reliable method for correcting coronal-plane deformities around the knee, with a tendency to achieve faster angular correction than TBP. Given the heterogeneity of included studies, further randomized controlled trials are needed to confirm these findings and guide implant choice based on patient-specific factors. Level III.