title: Fixator-assisted medial tibial plateau elevation to treat severe Blount's disease: outcomes at maturity.
abstract: BACKGROUND
  Severe forms of Blount's disease may be associated with medial tibial plateau (MTP) depression. Management should then take account of joint congruence, laxity, limb axis, torsional abnomality, leg length discrepancy (LLD) and eventual recurrence history.
  
  
  METHODS
  Eight knees (six patients) were managed in a single step comprising MTP elevation osteotomy, lateral epiphysiodesis and proximal tibia osteotomy to correct varus and rotational deformity. Fixation was achieved using an Ilizarov external fixator. Mean age was 10.5 years. Mean hip-knee-ankle (HKA) angle was 151°; distal femoral varus, 94°; metaphyseal-diaphyseal angle (MDA), 27°; and angle of depression of the medial tibial plateau (ADMTP), 42°. Predicted residual proximal tibial growth was 2.6 cm.
  
  
  RESULTS
  At a mean 48 months' follow-up, results were good in six cases, medium in one and poor (due to incomplete lateral epiphysiodesis) in one. Mean lateral tibial torsion was 9° and final LLD 11 mm. Weight-bearing was resumed at 2 months, and the fixator was removed at 5.5 months postoperatively. At end of follow-up, mean HKA angle was 179.6°, MDA 7.3° and ADMTP 5.4°.
  
  
  CONCLUSIONS
  This technically demanding procedure gave satisfactory results in terms of axes and congruence; longer term assessment remains needed.
  
  
  METHODS
  Level IV. Retrospective study.
authors.affiliation: Pediatric Orthopedics department, Robert-Debré Hospital, 48, boulevard Sérurier, 75019 Paris, France. franck.fitoussi@rdb.aphp.fr
authors.forename: F
authors.initials: F
authors.lastname: Fitoussi
authors.forename: B
authors.initials: B
authors.lastname: Ilharreborde
authors.forename: Y
authors.initials: Y
authors.lastname: Lefevre
authors.forename: P
authors.initials: P
authors.lastname: Souchet
authors.forename: A
authors.initials: A
authors.lastname: Presedo
authors.forename: K
authors.initials: K
authors.lastname: Mazda
authors.forename: G F
authors.initials: GF
authors.lastname: Penneçot
mesh_terms: D000293:Adolescent; D001848:Bone Diseases, Developmental / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D018889:Ilizarov Technique; D008297:Male; D055034:Osteochondrosis / Q000151:congenital* / Q000000981:diagnostic imaging / Q000601:surgery; D010027:Osteotomy; D011183:Postoperative Complications; D011859:Radiography; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome