Email this article Guided growth for leg length discrepancies, angular deformities and fixed knee flexion deformities treatment
- Authors: Volkova M.O.1, Kukueva D.M.2, Zherdev K.V.1, Chelpachenko O.B.1, Yatsyk S.P.1, Nikitenko I.E.1, Timofeev I.V.1
-
Affiliations:
- National Medical Research Center for Children’s Health
- Pirogov Russian National Research Medical University
- Issue: No 4 (2020)
- Pages: 62-69
- Section: Articles
- URL: https://pediatria.orscience.ru/2658-6630/article/view/62512
- DOI: https://doi.org/10.26442/26586630.2020.4.200501
- ID: 62512
Cite item
Full Text
Abstract
Materials and methods. The data of 4 groups with patients from 4 to 14 years old were studied. Group 1: 22 patients (34 knees), with angular deformities about the knee. Group 2: 38 patients (38 knees) with leg length discrepancies. Group 3: 15 patients (27 knees) with knee flexion contracture and cerebral palsy. Patients of 1–3 groups were operated by guided growth. The reference group (40 patients, 60 knees) was formed to determine the normal knee extension values in children according to X-ray and goniometry data.
Results. The mean angle of deformity before and after surgical treatment in group 1 were: 15.3 and 1.6º; in group 3: 160 and 4º recurrence, respectively, (p<0.05). The mean leg length discrepancy before and after surgery in group 2 were: 30 and 8 mm (p<0.05). The mean correction rate in group 1 was 0.6º per month, in group 2 – 0.9 mm per month, in group 3 – 2.9º per month. The mean score on the Gillette FAQ in group 3 increased after surgical treatment from 3.63 to 4.13. In reference group the mean angle of passive extension was 5º recurrence with goniometry lying on back, and 15º recurrence on X-ray. The mean active extension in a standing position was 4º recurrence. Smaller values of the tibiofemoral angle with goniometry in the standing position and passive extension with X-ray and goniometry can serve as clinical and radiological criteria for knee flexion contracture.
Conclusion. Guided growth is an effective technique for correcting leg length discrepancy and angular deformities about the knee in children. Close outpatient observation allows to not only timely identify orthopedic pathology, but also to effectively correct it without major reconstructive operation.
Full Text
About the authors
Mariia O. Volkova
National Medical Research Center for Children’s Health
Author for correspondence.
Email: volkova-mo@mail.ru
Graduate Student
Russian Federation, MoscowDzhamilia M. Kukueva
Pirogov Russian National Research Medical University
Email: dzhamaa7@gmail.com
Student
Russian Federation, MoscowKonstantin V. Zherdev
National Medical Research Center for Children’s Health
Email: drzherdev@mail.ru
D. Sci. (Med.), Prof.
Russian Federation, MoscowOleg B. Chelpachenko
National Medical Research Center for Children’s Health
Email: chelpachenko81@mail.ru
ORCID iD: 0000-0002-0333-3105
Cand. Sci. (Med.)
Russian Federation, MoscowSergei P. Yatsyk
National Medical Research Center for Children’s Health
Email: yatsyk@nczd.ru
ORCID iD: 0000-0001-6966-1040
D. Sci. (Med.), Prof., Corr. Memb. RAS
Russian Federation, MoscowIvan E. Nikitenko
National Medical Research Center for Children’s Health
Email: iv.nikitenko1984@yandex.ru
Cand. Sci. (Med.)
Russian Federation, MoscowIgor V. Timofeev
National Medical Research Center for Children’s Health
Email: doctor_timofeev@mail.ru
Cand. Sci. (Med.)
Russian Federation, MoscowReferences
- Попков А.В. Врожденное укорочение нижних конечностей у детей. Челябинск: Фотохудожник, 2011. [Popkov A.V. Congenital shortening of the lower limbs in children. Chelyabinsk: Photographer, 2011 (in Russian).]
- Моренко Е.С., Кенис В.М. Коррекция осевых деформаций коленного сустава у детей методом управляемого роста (обзор литературы). Ортопедия, травматология и восстановительная хирургия детского возраста. 2016; 4 (1): 57–62. [Morenko E.S., Kenis V.M. Korrektsiia osevykh deformatsii kolennogo sustava u detei metodom upravliaemogo rosta (obzor literatury). Ortopediia, travmatologiia i vosstanovitel’naia khirurgiia detskogo vozrasta. 2016: 4 (1); 57–62 (in Russian).]
- Игнатенко В.Л., Корнилов Н.Н., Куляба Т.А. и др. Эндопротезирование при вальгусной деформации коленного сустава (обзор литературы). Травматология и ортопедия России. 2011; 4 (62): 140–6. [Ignatenko V.L., Kornilov N.N., Kuliaba T.A. et al. Endoprotezirovanie pri val’gusnoi deformatsii kolennogo sustava (obzor literatury). Travmatologiia i ortopediia Rossii. 2011; 4 (62): 140–6 (in Russian).]
- Dodwell ER, Garner MR, Luderowski EM et al. Percutaneous Epiphysiodesis Using Transphyseal Screws: a Case Series Demonstrating High Efficacy. HSS J 2017; 13 (3): 255–62. doi: 10.1007/s11420-017-9549-5
- Martínez G, Drago S, Avilés C et al. Distal femoral hemiepiphysiodesis using screw and non-absorbable filament for the treatment of idiopathic genu valgum. Preliminary results of 12 knees. Orthop Traumatol Surg Res 2017; 103 (2): 269–73.
- MacWilliams BA, Harjinder B, Stevens PM. Guided growth for correction of knee flexion deformity: a series of four cases. Strat Traum Limb Recon 2011; 6: 83–90.
- Умнов В.В. Основные подходы к устранению сгибательной контрактуры коленного сустава у больных ДЦП. Травматология и ортопедия России. 2013; 3 (69): 119–24. [Umnov V.V. Osnovnye podkhody k ustraneniiu sgibatel’noi kontraktury kolennogo sustava u bol’nykh DTsP. Travmatologiia i ortopediia Rossii. 2013; 3 (69): 119–24 (in Russian).]
- Умнов В.В., Звозиль А.В., Умнов Д.В., Новиков В.А. Взаимосвязь сгибательных контрактур в суставах нижних конечностей и сагиттального профиля позвоночника у больных детским церебральным параличом: предварительное сообщение. Ортопедия, травматология и восстановительная хирургия детского возраста. 2016; 4: 71–6. [Umnov V.V., Zvozil’ A.V., Umnov D.V., Novikov V.A. Vzaimosviaz’ sgibatel’nykh kontraktur v sustavakh nizhnikh konechnostei i sagittal’nogo profilia pozvonochnika u bol’nykh detskim tserebral’nym paralichom: predvaritel’noe soobshchenie. Ortopediia, travmatologiia i vosstanovitel’naia khirurgiia detskogo vozrasta. 2016; 4: 71–6 (in Russian).]
- Martínez G, Gündel A, Ruiz P et al. Distal femoral hemiepiphysiodesis with screws and suture versus 8-plate for the treatment of genu valgum in children. Orthop Traumatol Surg Res 2019; 105 (4): 751–5.
- Ding J, Jin F, Zhao X et al. Hemiepiphysiodesis stapling induces ER stress apoptosis and autophagy in rat growth plates. Am J Transl Res 2019; 11 (3): 1486–97.
- Paley D. Principles of deformity correction. Springer, 2014
- Rejeb A, Fourchet F, Materne O et al. Beighton scoring of joint laxity and injury incidence in Middle Eastern male youth athletes: a cohort study. BMJ Open Sport Exerc Med 2019; 5: e000482. doi: 10.1136/bmjsem-2018-000482
- Маркс В.О. Ортопедическая диагностика: руководство-справочник. М., 1978. [Marx V.O. Orthopedic diagnostics: guidebook. Moscow, 1978 (in Russian).]
- Алабут А.В., Сикилинда В.Д., Чесников С.Г. и др. Анализ осложнений эндопротезирования коленного сустава. Известия высших учебных заведений. Северо-Кавказский регион. Естеств. науки. 2015; 1 (185): 96–100. [Alabut A.V., Sikilinda V.D., Chesnikov S.G. et al. Analiz oslozhnenii endoprotezirovaniia kolennogo sustava. Izvestiia vysshikh uchebnykh zavedenii. Severo-Kavkazskii region. Estestvennye nauki. 2015; 1 (185): 96–100 (in Russian).]
- Sharan D. Orthopedic surgery in cerebral palsy: Instructional course lecture. Indian journal of orthopaedics 2017; 51 (3): 240.
- Klatt J, Stevens PM. Guided growth for fixed knee flexion deformity. J Pediatr Orthop 2008; 28: 626–31. doi: 10.1097/BPO.0b013e318183d573
- Трофимова С.И., Буклаев Д.С., Петрова Е.В., Мулеванова С.А. Использование метода управляемого роста для устранения сгибательной контрактуры коленного сустава у пациентов с артрогрипозом: предварительные результаты. Ортопедия, травматология и восстановительная хирургия детского возраста. 2016; 4 (4): 64–70. [Trofimova S.I., Buklaev D.S., Petrova E.V., Mulevanova S.A. Ispol’zovanie metoda upravliaemogo rosta dlia ustraneniia sgibatel’noi kontraktury kolennogo sustava u patsientov s artrogripozom: predvaritel’nye rezul’taty. Ortopediia, travmatologiia i vosstanovitel’naia khirurgiia detskogo vozrasta. 2016; 4 (4): 64–70 (in Russian).]
- İnan M, Sarikaya İA, Yildirim E, Güven MF. Neurological complications after supracondylar femoral osteotomy in cerebral palsy. J Pediatr Orthop 2015; 35 (3): 290–5.
- Stout JL, Gage JR, Schwartz MH, Novacheck TF. Distal Femoral Extension Osteotomy and Patellar Tendon Advancement to Treat Persistent Crouch Gait in Cerebral Palsy. J Bone Joint Surg Am 2008; 90 (11): 2470–84.
- Дохов М.М., Машуков Т.С., Сертакова А.В. и др. Применение методики управляемого роста для коррекции осевых деформаций нижних конечностей у детей. Саратовский науч.-мед. журн. 2018; 14 (3): 529–32. [Dokhov M.M., Mashukov T.S., Sertakova A.V. et al. Primenenie metodiki upravliaemogo rosta dlia korrektsii osevykh deformatsii nizhnikh konechnostei u detei. Saratovskii nauch.-med. zhurn. 2018; 14 (3): 529–32 (in Russian).]
- Cain M, Stephenson M, Umapathysivam K et al. Effectiveness of different minimally invasive epiphysiodesis techniques in the management of pediatric leg length discrepancies: a systematic review protocol. JBI Evidence Synthesis 2016; 14 (12): 14–24.
- Wang KK, Novacheck TF, Rozumalski A, Georgiadis AG. Anterior guided growth of the distal femur for knee flexion contracture: clinical, radiographic, and motion analysis results. J Pediatr Orthop2019; 39 (5): e360–5.
- Stiel N, Babin K, Vettorazzi E et al. Anterior distal femoral hemiepiphysiodesis can reduce fixed flexion deformity of the knee: a retrospective study of 83 knees. Acta orthop 2018; 89 (5): 555–9.
- Букуп К., Букуп Й. Клиническое исследование костей, суставов и мышц. М.: Медицинская литература, 2018. [Bukup K., Bukup Y. Clinical examination of bones, joints and muscles. Moscow: Meditsinskaya literatura, 2018 (in Russian).]
Supplementary files
