Ellsworth Bridget K, Aitchison Alexandra H, Fabricant Peter D, Green Daniel W
Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA.
HSS J. 2022 Aug;18(3):399-407. doi: 10.1177/15563316211010720. Epub 2021 May 24.
Skeletally immature patients with coronal plane angular deformity (CPAD) may be at increased risk for intra-articular pathology and patellofemoral instability (PFI). These patients may be candidates for implant-mediated guided growth (IMGG) procedures with tension band plates to address CPAD in addition to procedures for concomitant knee pathology. However, there are limited data on performing these procedures simultaneously. : We sought to demonstrate the feasibility of combined procedures to address both knee pathology and concomitant CPAD using IMGG in skeletally immature patients. : We conducted a retrospective review of skeletally immature patients who underwent IMGG and concomitant surgery for anterior cruciate ligament reconstruction, osteochondritis dissecans repair, meniscus pathology, or PFI at a single institution by 2 surgeons between 2008 and 2019. Data on demographics, surgical details, follow-up, and complications were recorded. Deformity correction was assessed in a subset of eligible patients. : Of 29 patients meeting inclusion criteria, deformity correction was assessed in a subset of 17 patients (15 valgus, 2 varus). At final follow-up, 16 of 17 patients had mechanical tibiofemoral (mTFA) angles of <5° of varus or valgus. One patient developed "rebound" valgus >5° after plate removal. : The IMGG performed in the setting of treating intra-articular knee pathology is feasible and should be considered for skeletally immature patients with CPAD undergoing surgery for concomitant knee pathology.
患有冠状面角畸形(CPAD)的骨骼未成熟患者发生关节内病变和髌股关节不稳定(PFI)的风险可能会增加。除了针对膝关节合并病变的手术外,这些患者可能适合采用带张力带钢板的植入物介导引导生长(IMGG)手术来解决CPAD问题。然而,关于同时进行这些手术的数据有限。我们试图证明在骨骼未成熟患者中使用IMGG联合手术解决膝关节病变和合并CPAD的可行性。我们对2008年至2019年间在单一机构由2名外科医生为骨骼未成熟患者进行IMGG以及同时进行前交叉韧带重建、剥脱性骨软骨炎修复、半月板病变或PFI手术的情况进行了回顾性研究。记录了人口统计学、手术细节、随访和并发症的数据。在一部分符合条件的患者中评估了畸形矫正情况。在29名符合纳入标准的患者中,对17名患者(15名外翻、2名内翻)的子集进行了畸形矫正评估。在末次随访时,17名患者中有16名的机械性胫股(mTFA)角内翻或外翻<5°。1名患者在取出钢板后出现了>5°的“反弹”外翻。在治疗膝关节内病变的情况下进行IMGG是可行的,对于患有CPAD且正在接受膝关节合并病变手术的骨骼未成熟患者应考虑采用该方法。