Correction of Fixed Knee Flexion Deformity in Children Using Eight-plate Hemiepiphysiodesis

Study Overview
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Brief Summary
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The study aims to assess the effectiveness of hemiephysiodesis using eight plates in correction of fixed knee flexion deformities in children.

Detailed Description
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Flexion contractures of the knee are quite disabling. They produce deleterious effects on knee biomechanics, quadriceps function, energy expenditure during gait and the overall ability to ambulate. These deformities occur secondary to a number of different etiologies including; congenital, traumatic, inflammatory and neuromuscular disorders with cerebral palsy (CP) being on the top of the list. The main aim of correction of sagittal plane deformities of the knee is to restore the range of motion. Surgical options available for correction of knee flexion contractures include soft tissue modification, acute correction by osteotomies, gradual correction by external fixators and growth modulation by hemiephysiodesis.Extensive soft tissue surgery may be needed for correction of knee deformities with potential risk of neurovascular damage and wound complications. Supracondylar extension osteotomies have been widely used, however prolonged immobilization and associated neurovascular insults have always been major concerns. External fixators are cumbersome and may produce muscle tethering and pin tract infections. There are few studies in the literature reporting the use of anterior hemiepiphysiodesis for correction of knee flexion contracture. Our study question can be summarized as follows; Is hemiepiphysiodesis by eight plates effective for correction of fixed knee flexion deformities in children ?

Official Title
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Correction of Fixed Knee Flexion Deformity in Children Using Eight-plate Hemiepiphysiodesis

Conditions
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Knee Deformity

Intervention / Treatment
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* Procedure: Eight plate hemiepiphysiodesis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Fixed knee flexion deformity more than 10° Unilateral or bilateral cases 12 months or more predicted growth remaining No response to non-operative treatment (physical therapy, bracing, casting); Recurrent cases Exclusion Criteria: Dynamic deformities due to spasticity Deformities responding to conservative treatment

Ages Eligible for Study
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Minimum Age: 4 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Patients<br>13 child with fixed knee flexion deformity more than 10° on one or both sides with 12 months or more predicted growth remaining subjected to eight plate hemiepiphysiodesis of the distal femur | Procedure: Eight plate hemiepiphysiodesis<br>* Patient is positioned in a classic supine position. Under fluoroscopic guidance and tourniquet hemostasis, the distal femoral physis is identified. Two 3-cm incisions are made, one on either side of the patella, centred at the level of the physis. The capsule and synovium are opened to visualize the sulcus and place the plates just outside the articular portion of the joint surface, medially and laterally. Care is taken not to damage the periosteum and a needle is inserted into the physis. The 8-plate, which has a central hole, is slipped over the needle and screws inserted. After wound closure, a soft dressing is used, and the patient is allowed to ambulate as tolerated.<br>* Other names: Guided growth;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Degree of flexion deformity | The angle between the anterior borders of thigh and leg measured clinically with a goniometer | One year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Complications | Wound complications, metal failure | One year | 
| Rate of correction | Time needed for correction of deformity | One year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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knee, flexion deformity, hemiepiphysiodesis, eight plate, children