Microwave Ablation of the Pig Growth Plate: Proof of Concept for Minimally Invasive Epiphysiodesis. Different surgical methods for epiphysiodesis of limb length discrepancy (LLD) have been described. Although these methods are variably effective, they are associated with morbidity (pain and limp) and potential complications. Microwave ablation is a less-invasive opportunity to halt growth
Accuracy of 4 Different Methods for Estimation of Remaining Growth and Timing of Epiphysiodesis. The calculation of remaining growth in children and the timing of epiphysiodesis in those with leg-length discrepancy (LLD) is most often done with 4 methods: the Green-Anderson, White-Menelaus, Moseley straight-line graph, and multiplier methods. The aims of this study were to identify the most of short-leg length and LLD according to the White-Menelaus and other methods showed that they were significantly different (p ≤ 0.002). The calculated inhibition rate did not increase accuracy. The White-Menelaus method used with bone age and constant inhibition should be the preferred method when predicting remaining growth and the timing of epiphysiodesis in children between 10 and 17 years of age
The effectiveness of physeal bar resection with or without Hemi-Epiphysiodesis to treat partial growth arrest. To evaluate the outcomes of distal femoral, proximal tibial, and distal tibial physeal bar resection combined with or without the Hemi-Epiphysiodesis procedure and provide a better understanding of the application of physeal bar resection combined with Hemi-Epiphysiodesis procedure in the treatment of physeal bar growth arrest. We retrospectively reviewed the patients who suffered physeal bar and underwent physeal bar resection with or without the Hemi-Epiphysiodesis technique during 2010-2020. All were followed up for at least 2 years or to maturity. A modified mapping method was used to determine the area of a physeal bar by CT data. The aLDFA, aMPTA, aLDTA, MAD, and LLD were measured
Comparison of "Human" and Artificial Intelligence Hand-and-Wrist Skeletal Age Estimation in an Epiphysiodesis Cohort. We previously demonstrated that the White-Menelaus arithmetic formula combined with skeletal age as estimated with the Greulich and Pyle (GP) atlas was the most accurate method for predicting leg lengths and residual leg-length discrepancy (LLD) at maturity in a cohort of patients treated with epiphysiodesis. We sought to determine if an online artificial intelligence (AI)-based hand-and-wrist skeletal age system provided consistent readings and to evaluate how these readings influenced the prediction of the outcome of epiphysiodesis in this cohort. JPEG images of perioperative hand radiographs for 76 subjects were independently submitted by 2 authors to an AI skeletal
Growth arrest: leg length correction through temporary epiphysiodesis with a novel rigid staple (RigidTack). Temporary epiphysiodesis (ED) is commonly applied in children and adolescents to treat leg length discrepancies (LLDs) and tall stature. Traditional Blount staples or modern two-hole plates are used in clinical practice. However, they require accurate planning, precise surgical techniques
Does eight-plate epiphysiodesis of the proximal tibia in treating angular deformity create intra-articular deformity? Eight-plates are used to correct varus-valgus deformity (VVD) or limb-length discrepancy (LLD) in children and adolescents. It was reported that these implants might create a bony deformity within the knee joint by change of the roof angle (RA) after epiphysiodesis change in the bony morphology of the proximal tibia on AP radiographs in our patient population. In addition, no significant change in TS was detected on the lateral radiographs. A significant correction of the VVD in the lower limb axes was evident. Position of the implant did not correlate with TS change. Therefore, eight-plate epiphysiodesis is a safe and effective procedure for correcting VVD
Timing of Epiphysiodesis to Correct Leg-Length Discrepancy: A Comparison of Prediction Methods The purpose of this study was to compare the accuracy of different methods used to predict ultimate leg lengths and residual leg-length discrepancy in a group of patients treated with epiphysiodesis at our institution. Seventy-seven patients with adequate preoperative radiographs, no postoperative determinations differed by >1 year from chronological age. The prediction accuracy of each method was improved by using skeletal, rather than chronological, age. Error in prediction of the length of the short leg varied from a mean (and standard deviation) of 1.8 ± 1.2 cm for the straight-line graph to 2.5 ± 2.0 cm for the multiplier method. Prediction error for the long leg (after epiphysiodesis) varied from
A comparison of screw versus drill and curettage epiphysiodesis to correct leg-length discrepancy To compare two common surgical techniques of epiphysiodesis: drill/curettage epiphysiodesis (PDED) cross screw epiphysiodesis (PETS). The hypothesis is that the two techniques have similar efficacy but demonstrate differences in length of hospital stay (LOS), time to return to activity and complication rates. A retrospective review of growing children and adolescents less than 18 years old who required an epiphysiodesis with leg-length discrepancy (LLD) of 2 cm to 6 cm with minimum two years of follow-up was conducted. Characteristics including age at surgery, gender, epiphysiodesis location, side, operative time, LOS and hardware removal were compared across treatment groups. LLD, expected
Eight-plate epiphysiodesis: are we creating an intra-articular deformity? Guided growth using eight-plates is commonly used for correction of angular limb deformities in growing children. The principle is of tethering at the physeal periphery while enabling growth in the rest of the physis. The method is also applied for epiphysiodesis to correct limb-length discrepancy (LLD). Concerns have been
Long-term follow-up after bilateral percutaneous epiphysiodesis around the knee to reduce excessive predicted final height. Percutaneous epiphysiodesis (PE) around the knee to reduce predicted excessive final height. Studies until now included small numbers of patients and short follow-up periods. This Dutch multicentre, long-term, retrospective, follow-up study aimed to assess adult height (AH ), complications, knee function and patient satisfaction after PE. The primary hypothesis was that PE around the knee in constitutionally tall boys and girls is an effective treatment for reducing final height with low complication rates and a high level of patient satisfaction. 77 treated adolescents and 60 comparisons. Percutaneous epiphysiodesis. AH, complications, knee function, satisfaction. In the PE
Percutaneous medial hemi-epiphysiodesis using a transphyseal screw for caput valgum associated with developmental dysplasia of the hip. The purpose of this study was to evaluate the radiologic outcome of percutaneous medial hemi-epiphysiodesis using a transphyseal screw for the management of caput valgum associated with developmental dysplasia of the hip (DDH). Eighteen hips (18 patients) having caput valgum treated with screw hemi-epiphysiodesis were followed for more than 2 years, and were included in this study. The mean age at the time of the index operation was 8.3 years (range, 4.3 to 10.7 years) and age at the latest follow-up was 12.2 years (range, 9.4 to 16.4 years). The screw in 5 hips was changed into a longer one at postoperative 21.8 months (range, 14 to 29 months) because
Effect of greater trochanteric epiphysiodesis after femoral varus osteotomy for lateral pillar classification B and B/C border Legg-Calvé-Perthes disease: A retrospective observational study. This is a retrospective observational study. Greater trochanteric epiphysiodesis (GTE) has been recommended to prevent Trendelenburg gait and limitation of the hip joint motion due to trochanteric overgrowth
Percutaneous Epiphysiodesis Using Transphyseal Screws: a Case Series Demonstrating High Efficacy Percutaneous epiphysiodesis using transphyseal screws (PETS) has been associated with implant failure, implant prominence, angular deformities, and delayed growth inhibition. The aim of this study was to assess the complication rate and efficacy (defined as actual growth inhibition divided insertion angle (SIA), body mass index, and number of threads crossing the physis were calculated. Eight-two patients (126 treated physes) were included. The mean pre-operative LLD was 27.7 mm (SD = 7.5). Following epiphysiodesis, 15 had temporary pain (18%), five had temporary effusion (6.1%), four had broken implants (4.9%), four developed mild angulation (4.9%), and three had failed epiphysiodesis
Permanent epiphysiodesis for leg-length discrepancy (LLD). Protocol for a systematic review of percutaneous epiphysiodesis and Phemister technique. PROSPEROInternational prospective register of systematic reviews Print | PDFPermanent epiphysiodesis for leg-length discrepancy (LLD). Protocol for a systematic review of percutaneous epiphysiodesis and Phemister technique.Maria Tirta, Mette Holm PROSPERO registration. Further detail is provided here.CitationMaria Tirta, Mette Holm Hjorth, Søren Kold, Jette Frost Jepsen, Ole Rahbek. Permanent epiphysiodesis for leg-length discrepancy (LLD). Protocol for a systematic review of percutaneous epiphysiodesis and Phemister technique.. PROSPERO 2023 CRD42023435177 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID
An improved spreadsheet for calculating limb length discrepancy and epiphysiodesis timing using the multiplier method The multiplier method is a technique to predict limb length discrepancy (LLD) at maturity in pediatric patients. Various tools have been developed for performing the multiplier calculations to predict LLD and timing of epiphysiodesis. These include multiplier/growth applications -friendly. These features were modified and recreated in an improved Excel spreadsheet that uses patient age, sex, limb lengths, and previous lengthening surgeries as inputs to predict LLD at maturity and offer options for timing of epiphysiodesis for both congenital and developmental LLD. Our multiplier spreadsheet function was then compared to manual calculations and other multiplier tools for accuracy
Does radiofrequency ablation (RFA) epiphysiodesis affect adjacent joint cartilage? To test the hypothesis that epiphysiodesis made with radiofrequency ablation (RFA) is a safe procedure that disrupts the growth plate without damaging the adjacent joint articular cartilage. RFA epiphysiodesis was done during 8 min in vivo in 40 growing pig tibia physis. In addition, three tibiae were ablated magnetic field. On the burned articular cartilage, intensity changes were observed at MRI. We found no evidence of articular cartilage damage on the 40 8-min RFA procedures. The tibiae ablated for 16 min and 24 min showed intact joint cartilage. Epiphysiodesis using RFA is safe for the adjacent articular cartilage. This study shows that RFA can be done safely in the growing physis of pigs, even
Evaluation of a Mobile Application for Multiplier Method Growth and Epiphysiodesis Timing Predictions The multiplier method (MM) is frequently used to predict limb-length discrepancy and timing of epiphysiodesis. The traditional MM uses complex formulae and requires a calculator. A mobile application was developed in an attempt to simplify and streamline these calculations. We compared exercises that involved congenital and developmental limb-length discrepancies and timing of epiphysiodesis. The amount of time required to complete the exercises and the accuracy of the answers were evaluated for each subject. The test subjects answered 60% of the questions correctly using the traditional MM and 80% of the questions correctly using the MA (P=0.001). The average amount of time to complete
Physeal histological morphology after thermal epiphysiodesis using radiofrequency ablation Several treatments have been described for leg length discrepancy. Epiphysiodesis is the most commonly used because of its effectiveness. Thermal epiphysiodesis using radiofrequency ablation (RFA) alters the growth plate morphology without damaging the adjacent articular cartilage; it is a minimally invasive method that has shown excellent results in animal models. This study describes the macro and micro morphology after the procedure. Epiphysiodesis using RFA was performed in vivo for 8 min (92-98 °C) at two ablation sites (medial and lateral) in one randomly-selected tibia in eight growing pigs. The contralateral tibia was used as control. After 12 weeks, the pigs were killed and the tibiae
A systematic review of staples, tension-band plates and percutaneous epiphysiodesis screws for leg-length discrepancy (LLD) treatment. PROSPEROInternational prospective register of systematic reviews Print | PDFA systematic review of staples, tension-band plates and percutaneous epiphysiodesis screws for leg-length discrepancy (LLD) treatment.Maria Tirta, Mette Holm Hjorth, Jette Frost Jepsen . Further detail is provided here.CitationMaria Tirta, Mette Holm Hjorth, Jette Frost Jepsen, Ole Rahbek, Søren Kold. A systematic review of staples, tension-band plates and percutaneous epiphysiodesis screws for leg-length discrepancy (LLD) treatment.. PROSPERO 2023 CRD42023465953 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023465953Review questionThe aim of this study
Thermal epiphysiodesis performed with radio frequency in a porcine model. Current techniques for epiphysiodesis involve opening of cortical windows; use of staples, screws, and tension devices; and fusion with curettes or drills. Complications may have serious consequences. There is a need for a more reliable, precise, and less traumatic procedure that overcomes the known complications from existing techniques. We analyzed a new epiphysiodesis technique using radio-frequency ablation (RFA) in a porcine model. Six 35-kg and two 25-kg immature pigs were used. 1 hind leg of each animal was randomly selected and the proximal tibia growth plate was ablated laterally and medially. The contralateral leg was used as a control. MR images were obtained immediately after the ablation and 12 weeks