Evaluation of the Radial Procurvatum Using the Center of Rotation of Angulation Methodology in Chondrodystrophic Dogs

The radial joint orientation angles were calculated using the center of rotation of angulation (CORA) methodology within the frontal and sagittal planes in chondrodystrophic dog breeds, including Welsh Corgi, Dachshund, Pekinese, Poodle, Beagle and Maltese, and it was compared whether there is a statistically significant difference between the breeds. Radial joint orientation angles were obtained in eighty-eight dogs, including 23 Welsh Corgis, 16 Dachshunds, 14 Pekinese, 13 Maltese, 12 Poodles and 10 Beagles. Using the CORA methodology, the cranial proximal radial angle (CrPRA) and caudal distal radial angle (CdDRA) in the sagittal plane and medial proximal radial angle (MPRA) and lateral distal radial angle (LDRA) in the frontal plane were measured for the six breeds studied. The mean values of joint angles for each breed were compared statistically were observed. The CrPRA, CdDRA, and LDRA mean values of Dachshund and Welsh Corgi breeds were significantly smaller than other breeds, and in MPRA, Pekingese showed significantly smaller values than other breeds. This study confirms that the mean values of radial joint orientation angles can be significantly different among chondrodystrophic breeds. To accurately evaluate the degree of angular deformity of the radius, it may be helpful to refer to the average value for each breed with chondrodystrophy.

The effect of stem cells in repairing growth plate injury: a systematic review and meta-analysis

Background: Multiple studies have focused on stem cell-based therapies for growth plate injury.However, the results are not consistent.Objectives: This systematic review and meta-analysis were performed to evaluate the effects of stem cells on growth plate healing.Methods: A detailed search of relevant studies was conducted in three databases including Pub med, Cochrane library, and Embase databases, using the following keywords: “growth plate” or “physis” AND “stem cell” from inception to November 10, 2021. The standard mean difference (SMD) and 95% confidence interval (CI) for each individual study were extracted from the original studies based on relevant data and pooled to obtain integrated estimates using random effects modeling.Results: A total of 6 studies were identified. The results demonstrated that the angular deformity in the stem cell group was significantly lower than that in the control group at 4, 8,12 and 16weeks. The length discrepancy represented the degree of shortening deformity. In the stem cell group, the shortening deformity was milder than that of the control group at 16weeks. Meanwhile, at 16 weeks after surgery, the higher histologic scores in the stem cell group indicated that stem cell can significantly improve the repair quality of growth plate.Conclusions: This systematic review and meta-analysis confirmed that stem cell improved the rehabilitation of growth plate injury. However, larger-scale studies are needed to further support these findings.

Clinical Outcomes and Postoperative Complications After All-Epiphyseal Double-Bundle ACL Reconstruction for Skeletally Immature Patients

Background: The treatment strategy for pediatric anterior cruciate ligament (ACL) tears, especially in patients with open physes, remains controversial. Purpose: To assess clinical outcomes and postoperative complications after all-epiphyseal double-bundle ACL (DB-ACL) reconstruction for patients with open physes. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 102 patients aged ≤15 years who underwent ACL reconstruction at a single institution and had a minimum of 2 years of follow-up. Of these patients, 18 had undergone all-epiphyseal DB-ACL reconstruction (mean age, 12.4 ± 1.2 year) and 84 had undergone conventional DB-ACL reconstruction (mean age, 14.1 ± 0.9 year). The outcomes of the all-epiphyseal group were compared with those of the conventional group. Objective clinical outcomes included KT-1000 arthrometer measurements of side-to-side difference in anterior tibial translation, Lachman test grade, and pivot-shift test grade. Radiographic angular deformity (defined as >3° of the side-to-side difference in femorotibial angle) and incidence of second ACL injury were also compared. Results: The postoperative side-to-side difference in laxity significantly improved from 6.1 ± 2.4 to 0.6 ± 0.9 mm in the all-epiphyseal group ( P = .001), and postoperative laxity was similar to that of the conventional group (0.4 ± 0.8 mm; P = .518). A Lachman grade 1 positive result was observed in 20% of the all-epiphyseal group and 3% of the conventional group ( P = .042), and a pivot-shift grade 1 positive result was observed in 22% of the all-epiphyseal group and 4% of the conventional group ( P = .074). A total of 4 patients (26.7%) in the all-epiphyseal group and 4 (6.1%) in the conventional group demonstrated angular deformity ( P = .035). The incidence of postoperative ipsilateral ACL tear was 16.7% in the all-epiphyseal group and 23.8% in the conventional group ( P = .757). The incidence of contralateral ACL tear was 11.1% in the all-epiphyseal group and 14.3% in the conventional group ( P ≥ .999). Conclusion: All-epiphyseal DB-ACL reconstruction for skeletally immature patients achieved satisfactory clinical outcomes compared with conventional DB-ACL reconstruction. The incidence of ipsilateral graft rupture was relatively high in both groups. The all-epiphyseal group had a significantly higher incidence of angular deformity.

Inversed V-shaped High Tibial Osteotomy for Severe Varus Deformity due to Blount Disease: A Case Report

Introduction: Blount disease is a growth disorder of the medial proximal tibial physis causing a multi-planar deformity of the lower limb. Several types of surgical approaches have been described for the correction of angular deformity including external fixation, opened-/closed- wedge high tibial osteotomy (HTO), and tibial condylar valgus osteotomy. However, they are associated with various disadvantages such as limb length discrepancy, risk of infections, and delayed union at the osteotomy site, especially in cases of severe varus deformity. Case Report: We report a case of a 16-year-old boy with unilateral severe genu varum caused by Blount disease. Considering that the current case, the patient was severely obese and a highly active young boy with severe unilateral genu varum, with the epiphyseal line almost closed, and with no abnormalities with respect to the intra-articular anatomical structures, inverted V-shaped HTO was applied. After the treatment, the boy was not only able to perform his daily activities but was also able to participate in sports quite early. Although the required correction angle was quite large, inverted V-shaped HTO successfully corrects the deformity with minimal disadvantages Conclusion: Inverted V-shaped HTO would be selected as one of the effective treatments for a severely obese, young, and highly active patient suffering from severe genu varum caused by Blount disease. Keywords: Blount disease, genu varum, obesity, high tibial osteotomy (HTO), inverted V-shaped high tibial osteotomy (iVHTO).

Trampoline-related fractures of the proximal tibia in children

Background Trampoline-related fractures of the proximal tibial metaphysis are common in children and have been linked to subsequent valgus deformity of the tibia. The purpose of this study was to investigate the characteristics of trampoline-related proximal tibial fractures in young children. Methods We evaluated 40 patients with proximal tibial fracture after trampolining between 2013 and 2019. The median duration of follow-up was 18 months. Standing long leg radiographs were obtained at the last follow-up to evaluate angular deformity and limb length inequality in the patients. The measurements recorded include the lower limb length, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), mechanical axis deviation (MAD), and anatomical tibio-femoral angle (aTFA). The anterior tilt angle (ATA) was measured using a lateral radiograph of the tibia. Results The median age at injury was 40.0 months. Using trampoline with a heavier person was the most common mechanism of injury. aTFA and MAD were found to be increased towards the valgus at the last follow-up in our patient; however, the increase was not statistically significant (p = 0.692 and p = 0.973, respectively). The anterior tilt angle was increased in the injured leg at the last follow-up. But the change was not statistically significant (p = 0.09). Conclusions Using trampoline with a heavier person carries the risk of trampoline-related proximal tibial fracture in young children. We did not find a significant change in limb alignment at a minimum of one year of follow-up.

Growth modulation with tension-band plates for the correction of paediatric lower limb angular deformity: current concepts and indications for a rational use

Growth modulation (GM) with tension-band plates (TBPs) by tethering part of the growth plate is an established technique for the correction of angular deformities in children, and it has increasingly supplanted more invasive osteotomies. Growth modulation with TBPs is a safe and effective method to correct a variety of deformities in skeletally immature patients with idiopathic and pathological physes. The most common indication is a persistent deformity in the coronal plane of the knee exceeding 10°, with anterior and/or lateral joint pain, patellofemoral instability, gait disturbance, or cosmetic concerns. GM has also shown good results in patients with fixed flexion deformity of the knee and ankle valgus. This paper reviews the history of the procedure, current indications, and recent advances underlying physeal manipulation with TBPs. Cite this article: EFORT Open Rev 2021;6:658-668. DOI: 10.1302/2058-5241.6.200098

Premature Physeal Closure after a Non-Displaced Physeal Fracture of Distal Fibula

Premature physeal closure (PPC) may lead to clinically significant progressive angular deformity or leg length discrepancy. Many variables seem to play a role in determining which injuries result in PPC. A 8- year-old boy sustained a non-displaced physeal fracture of distal tibia and fibula. He showed no signs of PPC at 7 months post-injury. Seven years later, his ankle became painful. He had developed PPC of distal fibula causing angular ankle deformity, which was treated successfully by corrective osteotomy. To our knowledge, this is the first reported case of a non-displaced fracture of the distal fibula leading to PPC several years after the initial injury, which in our understanding was impossible to predict.

Enlightenment of Growth Plate Regeneration Based on Cartilage Repair Theory: A Review

The growth plate (GP) is a cartilaginous region situated between the epiphysis and metaphysis at the end of the immature long bone, which is susceptible to mechanical damage because of its vulnerable structure. Due to the limited regeneration ability of the GP, current clinical treatment strategies (e.g., bone bridge resection and fat engraftment) always result in bone bridge formation, which will cause length discrepancy and angular deformity, thus making satisfactory outcomes difficult to achieve. The introduction of cartilage repair theory and cartilage tissue engineering technology may encourage novel therapeutic approaches for GP repair using tissue engineered GPs, including biocompatible scaffolds incorporated with appropriate seed cells and growth factors. In this review, we summarize the physiological structure of GPs, the pathological process, and repair phases of GP injuries, placing greater emphasis on advanced tissue engineering strategies for GP repair. Furthermore, we also propose that three-dimensional printing technology will play a significant role in this field in the future given its advantage of bionic replication of complex structures. We predict that tissue engineering strategies will offer a significant alternative to the management of GP injuries.