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Guided Growth (Hemiepiphysiodesis)

What is guided growth?

Guided growth is a minimally invasive surgical procedure where a tension-band plate (also called a guided growth plate) is applied to a crooked bone to gradually straighten it as a child or adolescent grows. Guided growth is also called temporary hemiepiphysiodesis and is an alternative treatment option to performing an osteotomy and then straightening a bone. It is often used to treat bowlegs, knock knees or crooked bones that were caused by infection, injury, congenital conditions, or developmental problems.

What are tension-band plates?

Tension-band plates are about the size of a paperclip and are shaped like a number eight. Tension-band plates consist of a plate that is secured to the bone using two bone screws. The most commonly used tension-band plates are the eight-Plate and the Peanut Plate.

What are growth plates?

Growth plates, also called physes, are responsible for bone growth in children. Growth plates are located near each end of the femur (thigh bone) and tibia (shin bone) and are composed of a thin (3 mm, 3/25 of an inch) layer of specialized growth cartilage. As children become adults, the growth plates disappear and are replaced by bone.

How does guided growth work?

Most bone growth in the legs happens near the knees, so a tension-band plate is typically applied to the growth plates that are closest to the knee. In some cases, a tension-band plate is applied to the growth plate near the ankle. The tension-band plate is applied on only one side of the involved knee or ankle and is positioned so that it straddles the growth plate. This position causes bone growth to stop/slow on that side of the growth plate. The other side of the growth plate continues to grow normally and this gradually straightens the bone over time. It takes 6 to 12 months before the bone fully straightens, though sometimes the tension-band plate may need to remain in place for a year.

A tension-band plate is used to perform guided growth to correct a deformity in the femur

What happens during guided growth surgery?

Typically, the child/adolescent is placed under general anesthesia for less than an hour for this minimally invasive surgery. A 1-inch (2.5-cm) incision is made and a tension-band plate is inserted and secured with bone screws so that it straddles the growth plate. Most patients do not need to stay in the hospital overnight after the procedure.

What happens after guided growth surgery?

The patient is allowed to put weight on the leg immediately after surgery and will be able to return to normal activities within 2 to 3 weeks. Contact sports should be avoided for 3 weeks. There may be some swelling in the knee after the surgery, so physical therapy is recommended for a few weeks to prevent stiffness.

The patient will need to see the doctor 2 weeks after the procedure so that the doctor can check the incision and the knee’s range of motion. Follow-up visits should happen on a regular basis so that the doctor can monitor the gradual straightening of the bone. These follow-up visits are very important. If the tension-band plate remains in place for too long, the bone might become over corrected (angled in the opposite direction). After correction is achieved, the tension-band plate is removed during a surgical procedure. After removal, the bone will continue to grow normally.

What is rebound?

After treatment is completed and the tension-band plate is removed, the bone may begin to grow crooked again. This happens in some patients and is called rebound. When rebound is anticipated, the doctor may recommend partial removal of the tension-band plate so that it can be easily reinserted in the future if the bone begins to grow crooked. Partial removal means that instead of removing the plate and both screws, the doctor will remove only one screw and leave the plate and the other screw in place.

Is the timing of guided growth important?

The timing of the surgery to insert and remove the tension-band plate is very important. If the timing is not correct, the angular deformity might be under corrected or it might be over corrected (angled in the opposite direction). The International Center for Limb Lengthening has developed the Multiplier app, which uses clinically validated formulae to predict the ideal age to insert and remove tension-band plates. Watch this video to see the Multiplier app in action:

Video demonstrates how the Multiplier App, developed at the International Center for Limb Lengthening, is used to predict when a patient should start and stop treatment

Accuracy of calculations may be improved by examining X-rays of the hand or elbow to determine the child’s “bone age,” which is an estimate of the maturity of the skeletal system. A child’s bone age may be different than the child’s chronological age.

Does guided growth work in adults?

Guided growth does not work in adults (people who are skeletally mature). It only works in children and adolescents while their bones are still growing.