Guided Growth for Angular Deformities

There is a range of 'normal' lower limb alignment in children.  Babies will commonly be bow-legged (genu varum) and then will transition to a knock-kneed (genu valgum) in early childhood, before straightening out again with further growth in late childhood and early adolescent years.  We call this 'physiologic varus and valgus'.  

However, there are patients that are out of the range of normal with angular deformities.  This can be for various reasons, such as a metabolic disturbance like vitamin D deficiency.  Sometimes we do not know the cause of the angular deformity.  We do commonly see angular deformities in children who are overweight and we think this may be due to high load through the growth plates of the knee, which alters growth.

In children who are clearly out of the population range of normal values for their age, guided growth is a method used to tether the growth plate on one side of the joint and allow it to continue growing on its opposite side. Thus with growth continuing on, the deformity can correct over many months.

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Before and after pictures of guided growth for genu valgumThis is an example of an adolescent that was continuing to get worsening knock-kneed appearance (genu valgum). The patient had small plates applied to the inside of the femurs and got correction of alignment after several months.  

Guided growth is not appropriate for every patient and these children do require an additional short day surgery to remove these devices once correction is achieved.  This method does not work in patients that have finished growing.  It is important to come back for regular follow up to avoid overcorrection. 

Guided growth in Children Patient Information*

*Please note that Dr Kollias has no personal financial interest in the company manufacturing or supplying this device.