Management of Deformities Around the Knee in Skeletal Dysplasia and a Review of Current Literature on Guided Growth in Skeletal Dysplasia
Volume 11 | Issue 1 | Januar-April 2025 | Page: 25-33 | Akash Kumar Ghosh, Puneeth K Pai, Vikas Ellur
DOI- https://doi.org/10.13107/ijpo.2025.v11.i01.218
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2024; The Author(s).
Submitted: 14/02/2025; Reviewed: 26/02/2025; Accepted: 02/04/2025; Published: 10/04/2025
Authors: Akash Kumar Ghosh M.Ch (Paed. Ortho.) [1], Puneeth K Pai MS Ortho [1], Vikas Ellur MS Ortho [1]
[1] Department of Orthopaedics, Paediatric Orthopaedics Unit, Narayana Healthcity, Bengaluru, Karnataka, India.
Address of Correspondence
Dr. Akash Kumar Ghosh,
Department of Orthopaedics, Paediatric Orthopaedics Unit, Narayana Healthcity, Bengaluru, Karnataka, India.
E-mail: akashgh994@gmail.com
Abstract
Skeletal dysplasias are a heterogeneous group of disorders characterized by abnormal bone and cartilage formation, often presenting with complex lower limb deformities, particularly around the knee. This review provides a comprehensive overview of the current evidence regarding the management of knee deformities in skeletal dysplasias.
Deformities may arise due to asymmetric physeal. involvement, unequal growth of paired bones, or soft tissue contractures. A thorough history, comprehensive examination, and appropriate imaging are, essential for accurate assessment. Instrumented gait analysis provides valuable insights into the dynamic impact of deformities.
Treatment planning should consider the multifocal and multiplanar nature of deformities, unpredictable growth patterns, bone quality, and anesthetic risks. Guided growth is a safe and effective option for correcting coronal and sagittal plane deformities in children with at least two years of growth remaining. Acute correction using osteotomies and internal fixation is preferred when the center of rotation of angulation (CORA) is further from the physis. Gradual correction using external fixators is useful for multiplanar and multifocal deformities with limb length discrepancy. A multidisciplinary collaboration and astute planning are important for ensuring optimal outcomes in the management of knee deformities in skeletal dysplasias.
Keywords: Bone disease, Developmental, Osteotomy, Growth plate, Epiphysis, Guided growth
References
1. Brown RR, Monsell F. Understanding the skeletal dysplasias. Current Orthopaedics. 2003;17:44–55.
2. Thacker MM, Ditro C, Mackenzie WGS, Mackenzie WG. Limb Lengthening and Deformity Correction in Patients with Skeletal Dysplasias. In: Sabharwal S, Iobst CA, editors. Pediatric Lower Limb Deformities: Principles and Techniques of Management [Internet]. Cham: Springer International Publishing; 2024 [cited 2025 Apr 6]. p. 537–59. Available from: https://doi.org/10.1007/978-3-031-55767-5_26
3. Borgo A, Cossio A, Gallone D, Vittoria F, Carbone M. Orthopaedic challenges for mucopolysaccharidoses. Ital J Pediatr. 2018;44:123.
4. Weiner DS, Tank JC, Jonah D, Morscher MA, Krahe A, Kopits S, et al. An operative approach to address severe genu valgum deformity in the Ellis-van Creveld syndrome. Journal of Children’s Orthopaedics. 2014;8:61–9.
5. Lee ST, Song HR, Mahajan R, Makwana V, Suh SW, Lee SH. Development of genu varum in achondroplasia: RELATION TO FIBULAR OVERGROWTH. The Journal of Bone & Joint Surgery British Volume. 2007;89-B:57–61.
6. Al Kaissi A, Kenis V, Melchenko E, Chehida FB, Ganger R, Klaushofer K, et al. Corrections of Lower Limb Deformities in Patients with Diastrophic Dysplasia. Orthopaedic Surgery. 2014;6:274–9.
7. Cho T-J, Choi IH, Chung CY, Yoo WJ, Park MS, Lee DY. Hemiepiphyseal Stapling for Angular Deformity Correction Around the Knee Joint in Children With Multiple Epiphyseal Dysplasia. Journal of Pediatric Orthopaedics. 2009;29:52.
8. Lachman RS. Neurologic abnormalities in the skeletal dysplasias: A clinical and radiological perspective. American Journal of Medical Genetics. 1997;69:33–43.
9. Horn J, Leardini A, Benedetti MG, Hestnes TM, Mindler G, Wekre LL, et al. Fully instrumented gait analysis in rare bone diseases – A scoping review of the literature. Gait & Posture. 2025;118:168–77.
10. Rego FRQ, Oliveira HFV de, Rolim Filho EL. Three-dimensional Evaluation of Gait: Kinetics, Kinematics, and Electromyographic in Patients with Mucopolysacharidosis Types IV and VI. Rev bras ortop. 2025;59:737–44.
11. Bayhan IA, Er MS, Nishnianidze T, Ditro C, Rogers KJ, Miller F, et al. Gait Pattern and Lower Extremity Alignment in Children With Diastrophic Dysplasia. Journal of Pediatric Orthopaedics. 2016;36:709.
12. Garman CR, Graf A, Krzak J, Caudill A, Smith P, Harris G. Gait Deviations in Children With Osteogenesis Imperfecta Type I. Journal of Pediatric Orthopaedics. 2019;39:e641.
13. Silva MS, Fernandes ARC, Cardoso FN, Longo CH, Aihara AY. Radiography, CT, and MRI of Hip and Lower Limb Disorders in Children and Adolescents. RadioGraphics. 2019;39:779–94.
14. Kraus M, Pertman L, Eshed I. What’s new in pediatric musculoskeletal imaging. Journal of Children’s Orthopaedics. 2025;19:109–18.
15. Meyrignac O, Moreno R, Baunin C, Vial J, Accadbled F, Sommet A, et al. Low-dose biplanar radiography can be used in children and adolescents to accurately assess femoral and tibial torsion and greatly reduce irradiation. Eur Radiol. 2015;25:1752–60.
16. Silva FD, Chemin RN, Ormond Filho AG, Guimarães JB, Zorzenoni FO, Nico MAC. The role of stereoradiography in the evaluation of lower limb deformities. Radiol Bras. 2022;55:104–12.
17. Alman B. Skeletal dysplasias and the growth plate. Clinical Genetics. 2008;73:24–30.
18. Kitoh H, Kamiya Y, Mishima K, Matsushita M, Kaneko H, Kitamura A, et al. Guided growth for coronal lower limb deformities in skeletal dysplasia. Journal of Pediatric Orthopaedics B. 2023;32:157.
19. Halloum A, Kold S, Rölfing JD, Abood AA, Rahbek O. Correction of rotational deformities in long bones using guided growth: a scoping review. 2024 [cited 2025 Apr 1]; Available from: https://eor.bioscientifica.com/view/journals/eor/9/2/EOR-23-0149.xml
20. Ulusaloglu AC, Asma A, Rogers KJ, Thacker MM, Mackenzie WGS, Mackenzie WG. Risk Factors for Rebound After Correction of Genu Valgum in Skeletal Dysplasia Patients Treated by Tension Band Plates. Journal of Pediatric Orthopaedics. 2022;42:190.
21. Zaidman M, Simanovsky N, Goldman V, Weisstub E. Correction of Femoral Torsional Deformities by Rotational Guided Growth. Journal of Clinical Medicine. 2024;13:7514.
22. Martel GA, Holmes L, Sobrado G, Araujo ES, Paley D, Praglia F, et al. Rotational-Guided Growth. Journal of Limb Lengthening & Reconstruction. 2018;4:97.
23. Klatt J, Stevens PM. Guided Growth for Fixed Knee Flexion Deformity. Journal of Pediatric Orthopaedics. 2008;28:626.
24. Trofimova SI, Ивановна ТС, Buklaev DS, Степанович БД, Petrova EV, Владимировна ПЕ, et al. Guided Growth for Correction of Knee Flexion Contracture in Patients with Arthrogryposis: Preliminary Results. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4:64–70.
25. McClure PK, Alrabai HM, Herzenberg JE. Growth modulation for fixed flexion contracture of the knee: a comparison of two techniques. Journal of Pediatric Orthopaedics B. 2021;30:37.
26. Cooper GA, Southorn T, Eastwood DM, Bache CE. Lower Extremity Deformity Management in MPS IVA, Morquio-Brailsford Syndrome: Preliminary Report of Hemiepiphysiodesis Correction of Genu Valgum. Journal of Pediatric Orthopaedics. 2016;36:376.
27. McClure PK, Kilinc E, Birch JG. Growth Modulation in Achondroplasia. Journal of Pediatric Orthopaedics. 2017;37:e384.
28. Yilmaz G, Oto M, Thabet AM, Rogers KJ, Anticevic D, Thacker MM, et al. Correction of Lower Extremity Angular Deformities in Skeletal Dysplasia With Hemiepiphysiodesis: A Preliminary Report. Journal of Pediatric Orthopaedics. 2014;34:336.
29. Sağlam Y, Demirel M, Yildirim AM, Bilgili F, Şen C. CORONAL PLANE GROWTH MODULATION FOR GENU VALGUM IN SKELETAL DYSPLASIA. Acta ortop bras. 2022;30:e249113.
30. Hösl M, Afifi FK, Thamm A, Göttling L, Holzapfel BM, Wagner F, et al. The Effectiveness of Growth Modulation Using Tension Band Plates in Children With Achondroplasia in Comparison to Children With Idiopathic Frontal Axial Deformities of the Knee. Journal of Pediatric Orthopaedics. 2025;45:e84.
31. Ulusaloglu AC, Asma A, Silva LC, Miller F, Mackenzie WG, Mackenzie WGS. Growth Modulation by Tension Band Plate in Achondroplasia With Varus Knee Deformity: Comparison of Gait Analysis Measurements. Journal of Pediatric Orthopaedics. 2023;43:168.
32. Makarewich CA, Zhang E, Stevens PM. Hemiepiphysiodesis for Lower Extremity Coronal Plane Angular Correction in the Distal Femur and Proximal Tibia in Children With Achondroplasia. Journal of Pediatric Orthopaedics. 2023;43:e639.
33. Franzone JM, Wallace MJ, Rogers KJ, Strudthoff EK, Bober MB, Kruse RW, et al. Multicenter Series of Deformity Correction Using Guided Growth in the Setting of Osteogenesis Imperfecta. Journal of Pediatric Orthopaedics. 2022;42:e656.
34. Kang S, Kim JY, Park S-S. Outcomes of Hemiepiphyseal Stapling for Genu Valgum Deformities in Patients With Multiple Hereditary Exostoses: A Comparative Study of Patients With Deformities of Idiopathic Cause. Journal of Pediatric Orthopaedics. 2017;37:265.
35. Bram JT, Li DT, Tracey OC, Lijesen E, Chipman DE, Widmann RF, et al. Hemiepiphysiodesis for Genu Valgum in Patients With Multiple Hereditary Exostoses. Journal of Pediatric Orthopaedics. 2024;44:e406.
36. Ranade AS, Oka GA, Belthur MV, Shah H, Herman MJ, Fernandes JA, et al. An International Consensus on Evaluation and Management of Idiopathic Genu Valgum: A Modified Delphi Survey. Journal of Pediatric Orthopaedics. :10.1097/BPO.0000000000002908.
37. Pacelli LL, Gillard J, McLoughlin SW, Buehler MJ. A Biomechanical Analysis of Donor-Site Ankle Instability Following Free Fibular Graft Harvest. JBJS. 2003;85:597.
38. Myers GJC, Bache CE, Bradish CF. Use of Distraction Osteogenesis Techniques in Skeletal Dysplasias. Journal of Pediatric Orthopaedics. 2003;23:41.
| How to Cite this Article: Ghosh A, Pai PK, Ellur V | Management of Deformities Around the Knee in Skeletal Dysplasia and a Review of Current Literature on Guided Growth in Skeletal Dysplasia | International Journal of Paediatric Orthopaedics | January-April 2025; 11(1): 25-33 . |
