Coronal deformity of the knee in childrens and adolescents. A systematic review of current orthopaedics treatments

Objectives. Coronal deformities of the knee in skeletally immature patients are often physiological and resolve spontaneously. When this is not the case a surgical correction is required. As limited data are available on the effectiveness of the different surgical procedures to correct coronal deformities in skeletal immature patients, a systematic review was conducted to analyse the surgical outcomes, complications and recurrent deformity rate in idiopathic and pathologic coronal deformities. Patients and Methods. A systematic review of articles published between January 1990 and May 2022 was performed. Pub med, Scopus, Google scholar and EMBASE were used for the research. Studies analysing the results of hemiepiphysiodesis for length leg discrepancy were excluded as well as those published in non-english literature. Clinical and radiological parameters before and after surgery were collected. Results. Of the 205 studies initially selected, 47 met the inclusion criteria. There were 3307 patients (2028 men and 1279 women) and 5949 knees. The mean age at surgery was 10.5 years (range 4.1-18 years). Mean length of follow-up was 17 months (range 6-67 months). Sixty-four per cent of the patients had idiopathic varus-valgus deformity, 36% had secondary deformities. Clinical and radiographic parameters were generally improved after surgery but statistical analysis was missing in many studies. Patient satisfaction was 90% or more in 74% of the study. Conclusions. Coronal knee deformity in children and adolescents may be treated successfully with emiepiphysiodesis of the knee. The rate of recurrency appears associated with patients related factors, including deformity secondary to specific pathologies, young age at the time of surgery, severity of the deformity and high BMI. This investigation highlights the need for further studies in which the surgical techniques currently used were compared in a randomized prospective analysis.