gms | German Medical Science

Objectives: Reduction of excessive predicted final height may be achieved by hormonal treatment, or surgically by manipulating the growth plate around the knee through total epiphysiodesis (ED). Lately, hormonal therapy has been linked to adverse effects such as an overall increased cancer risk and decreased fertility in women. ED, on the other hand, allows an improvement of body proportions in tall stature patients who present excessive leg length. ED for inhibition of growth can either be performed temporarily by physeal compression through stapling of the growth plate, or permanently through irreversible destruction of the physis.

The present study evaluates the preliminary results of two novel devices for temporary and permanent ED of the knee for reduction of excessive predicted final height.

Methods: Since 2015, bilateral ED was performed in a cohort of 34 patients (16 girls, 18 boys) with tall stature. Temporary ED was conducted in 11 patients (32%) through bilateral implantation of 4 RigidTacks™ (RT; Merete, Berlin, Germany) "around the knee". 23 patients (68%) received a permanent ED, performed with an EpiStop™ punch (ES; Eberle, Wurmberg, Germany). Mean follow-up (FU) time was 2.7 years.

Figure 1 [Fig. 1]

Results and conclusion: Mean age at surgery was 12.7 years (girls: 12.3; boys: 13.1). Patients presented a mean body height of 179.6 cm (girls: 175.3 cm; boys: 183.5 cm) at surgery. The mean predicted final height was 199.7 cm (girls: 190.6 cm; boys: 207.8 cm). At the time of last FU, 23 patients (67.6%) had achieved skeletal maturity. The mean height of those 23 patients was 190.8 cm (girls: 183.6 cm; boys: 199.0 cm) at the time of last FU. In average, a reduction of 7.0 cm (girls: 6.2 cm; boys: 7.9 cm) of the predicted final height was achieved. 1 wound infection was observed in the RT and in the ES group, respectively. Implant-associated complications occurred in 1/11 (9.0%) treatments within the RT group. Secondary frontal plane deformities were detected in 5/11 (45.5%) treatments in the RT group and in 1/23 (4.3%) treatment in the ES group.

While temporary ED offers the advantage of reversibility, timing of the surgical intervention has to be calculated more precisely than in permanent ED. Moreover, temporary ED is associated with implant-related complications, and requires a second intervention for implant removal. In conclusion, RT and ES seem to be equally effective for ED for reduction of excessive predicted final height, while ES may be slightly superior in regard of associated complications and cosmetical outcome. However, the small size and heterogeneity of the study cohort limit comparability and statistical evaluation. Moreover, long-term results are awaited.