How to avoid genu recurvatum in leg-length discrepancy treated with tension-band plates. A volumetric magnetic resonance analysis
Por:
Jurado-Ruiz M, Rovira-Martí MP, Riera L and García-Fontecha CG
Publicada:
1 nov 2024
Ahead of Print:
1 jun 2024
Resumen:
Aims and objectives: Genu recurvatum deformity after treatment of leg-length discrepancy (LLD) with tensionband plating is a recognized, but poorly described phenomenon in medical literature. The aim of this study was to evaluate clinical and radiological features of patients treated with tension-band plating for LLD assessing the development of a recurvatum deformity and its relationship to plate and screw disposition in a transversal plane, thus attempting to establish optimal plate positioning. Materials and methods: Retrospective study of children with LLD treated with tension-band plating. Primary endpoints were clinical and radiological knee recurvatum and anterior and posterior physeal areas measured drawing a line spanning from the lateral to the medial tension-band plates in the transverse plane using volumetric magnetic resonance imaging (vMRI). These findings were compared between patients with and without knee recurvatum. Results: Twelve children (mean age 11.7 years) were included. Average follow-up was 2.6 years (1.5-5.0). Tension-band plating led to a significant reduction in LLD (mean, 15 mm). Six patients (50 %) developed clinical genu recurvatum (mean, 22 degrees). According to vMRI, patients with genu recurvatum had a larger posterior to anterior physeal area ratio in both distal femur (1.6 versus 0.9, p < 0.05) and proximal tibial physes (2.2 versus 1.0, p < 0.05). Conclusion: The optimal position of the tension-band plates in distal femoral and proximal tibial physes should be in a point where a posterior to anterior physeal areas ratio is around 1.0, so as to achieve an even distribution of the physeal areas in the multidimensional physeal transverse plane. This point anatomically corresponds in the sagittal X-ray view to an imaginary line located just anterior to the posterior diaphyseal cortical bone on a true lateral radiograph for both femur and tibia.
Filiaciones:
Jurado-Ruiz M:
Department of Orthopedic Surgery and Traumatology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119, 08035, Barcelona, Spain
Reconstructive Surgery of the Locomotor System, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 129, 08035, Barcelona, Spain
Riera L:
Department of Pediatric Radiology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, 08035, Barcelona, Spain
García-Fontecha CG:
Reconstructive Surgery of the Locomotor System, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 129, 08035, Barcelona, Spain
Department of Pediatric Orthopedics and Traumatology, Sant Joan de Déu Hospital, Passeig de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain
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