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Sanjeev Sabharwal - One of the best experts on this subject based on the ideXlab platform.
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ipsilateral osteochondritis dissecans like distal femoral lesions in children with Blount Disease prevalence and associated findings
Strategies in Trauma and Limb Reconstruction, 2020Co-Authors: Folorunsho Edoborosula, Cornelia Wenokor, Caixia Zhao, Tamir Bloom, Sanjeev SabharwalAbstract:Author(s): Edobor-Osula, Folorunsho; Wenokor, Cornelia; Bloom, Tamir; Zhao, Caixia; Sabharwal, Sanjeev | Abstract: Purpose:Our goal was to assess the prevalence of ipsilateral distal femoral osteochondritis dissecans (OCD)-like lesions in children with Blount Disease, including factors associated with this finding. Materials and methods:Characteristics of patients with an OCD-like lesion on an imaging study [(X-ray and/or magnetic resonance imaging (MRI)] were compared with those without such a finding. Results:Over a 12-year period, 6/63 (10%) skeletally immature patients (9/87 limbs) with Blount Disease had an OCD-like lesion visible on plain radiographs. Based on available MRI, 7/37 (19%) patients or 10/53 (19%) limbs had an OCD-like distal femoral lesion. All lesions were noted in the posterior third of the weight-bearing portion of the medial femoral condyle with intact overlying articular cartilage. All patients with OCD-like lesions were followed for an average of 1.9 years (range: 1-2.6 years), and complete radiographic resolution of lesion was noted in 7/9 limbs (78%). There was no association of the presence of OCD-like lesion with early- vs late-onset Disease, gender, age at imaging, laterality, magnitude of deformity [mean mechanical axis deviation (MAD) 63.3 vs 71.9 mm], mean mechanical lateral distal femoral angle (mLDFA; 91.3 vs 89.7°), and mean medial proximal tibial angle (MPTA; 71.7 vs 71.8°). Children with an OCD-like lesion tended to have a lower mean body mass index (BMI; 21 vs 36, p = 0.003). Conclusion:The overall prevalence of OCD-like lesions in the medial femoral condyle in children with Blount Disease lesions is 10% using plain radiographs and at least 19% on MRI. Based on the numbers available, we were unable to demonstrate any associations between the presence of such lesions and the patient's age, gender, or magnitude of varus deformity. Further research is needed to fully ascertain the aetiology and natural history of these benign appearing osteochondral imaging findings in children with Blount Disease. Our current data support that these lesions do resolve with time and that no surgical intervention targeted at the femoral OCD-like lesion is warranted. Level of evidence:Diagnostic study Level III. How to cite this article:Edobor-Osula F, Wenokor C, Bloom T, et al. Ipsilateral Osteochondritis Dissecans-like Distal Femoral Lesions in Children with Blount Disease: Prevalence and Associated Findings. Strategies Trauma Limb Reconstr 2019;14(3):121-125.
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risk factors for failure of temporary hemiepiphysiodesis in Blount Disease a systematic review
Journal of Pediatric Orthopaedics B, 2020Co-Authors: Bensen Fan, Caixia Zhao, Sanjeev SabharwalAbstract:There is limited information regarding the use of temporary hemiepiphysiodesis for Blount Disease. We performed a systematic review of patients treated for Blount Disease using either extraperiosteal staples or plates to identify characteristics affecting clinical outcome, including the need for unplanned procedures. A total of 53 patients (63 bone segments) underwent temporary hemiepiphysiodesis at a mean age of 8.8 years (1.8-14.7 years). Overall, 32/63 (51%) segments achieved neutral mechanical axis and 31/63 (49%) underwent unplanned subsequent procedures, with or without a subsequent osteotomy. On the basis of the available heterogeneous data, neither age at index surgery nor the type of implant correlated with the need for unplanned additional surgeries.
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ocd like distal femoral lesions in children with Blount Disease what is the clinical relevance
Orthopaedic Journal of Sports Medicine, 2019Co-Authors: Folorunsho Edoborosula, Cornelia Wenokor, Tamir Bloom, Ciaxia Zhao, Sanjeev SabharwalAbstract:What was the question?The purpose of this study was to evaluate the prevalence of OCD-like lesions around the knee in children with Blount Disease. Additionally, we planned to describe the morpholo...
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treatment of infantile Blount Disease an update
Journal of Pediatric Orthopaedics, 2017Co-Authors: Samir Sabharwal, Sanjeev SabharwalAbstract:Although the core principles of managing infantile Blount Disease generally remain unchanged, treatment modalities have evolved over the years. Consensus has yet to be reached regarding the efficacy of bracing. Children with Blount Disease commonly have advanced bone age, which may impact the timing and magnitude of (over) correction of angular deformity. Techniques of growth modulation, based on the tension band principle, continue to gain popularity. Although there are limited reports in the last decade on proximal tibial osteotomy for this developmental disorder, both acute and gradual correction remain viable treatment options in the appropriate setting. In certain older children (>7 y old) with advanced stages of the Disease, a medial hemiplateau elevation combined with lateral proximal tibial hemiepiphysiodesis may be needed to address the epiphyseal deformity. Given the possibility of unpredictable proximal tibial physeal activity, all children with Blount Disease should be followed at regular intervals till skeletal maturity. To provide sufficient granularity for pooled analyses and help establish evidence-based clinical guidelines, standardization of reporting clinical outcomes among children with Blount Disease is encouraged.
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are patient demographics different for early onset and late onset Blount Disease results based on meta analysis
Journal of Pediatric Orthopaedics B, 2015Co-Authors: Steven Rivero, Caixia Zhao, Sanjeev SabharwalAbstract:Early-onset and late-onset Blount Disease has been described with some clinical overlap between the two forms. Using PRISMA guidelines, we searched for articles that included demographics of patients with both types of Blount Disease. On the basis of 24 articles that met our inclusion criteria, patients with early-onset Blount Disease were more likely to have bilateral involvement [odds ratio (OR) 4.30, 95% confidence interval (CI) 2.27-8.17] and less likely to be Black (OR 0.20, 95% CI 0.08-0.53) or male (OR 0.32, 95% CI 0.13-0.78). Our results confirm that differences based on laterality, race, and sex exist between the two forms of Blount Disease.
Caixia Zhao - One of the best experts on this subject based on the ideXlab platform.
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ipsilateral osteochondritis dissecans like distal femoral lesions in children with Blount Disease prevalence and associated findings
Strategies in Trauma and Limb Reconstruction, 2020Co-Authors: Folorunsho Edoborosula, Cornelia Wenokor, Caixia Zhao, Tamir Bloom, Sanjeev SabharwalAbstract:Author(s): Edobor-Osula, Folorunsho; Wenokor, Cornelia; Bloom, Tamir; Zhao, Caixia; Sabharwal, Sanjeev | Abstract: Purpose:Our goal was to assess the prevalence of ipsilateral distal femoral osteochondritis dissecans (OCD)-like lesions in children with Blount Disease, including factors associated with this finding. Materials and methods:Characteristics of patients with an OCD-like lesion on an imaging study [(X-ray and/or magnetic resonance imaging (MRI)] were compared with those without such a finding. Results:Over a 12-year period, 6/63 (10%) skeletally immature patients (9/87 limbs) with Blount Disease had an OCD-like lesion visible on plain radiographs. Based on available MRI, 7/37 (19%) patients or 10/53 (19%) limbs had an OCD-like distal femoral lesion. All lesions were noted in the posterior third of the weight-bearing portion of the medial femoral condyle with intact overlying articular cartilage. All patients with OCD-like lesions were followed for an average of 1.9 years (range: 1-2.6 years), and complete radiographic resolution of lesion was noted in 7/9 limbs (78%). There was no association of the presence of OCD-like lesion with early- vs late-onset Disease, gender, age at imaging, laterality, magnitude of deformity [mean mechanical axis deviation (MAD) 63.3 vs 71.9 mm], mean mechanical lateral distal femoral angle (mLDFA; 91.3 vs 89.7°), and mean medial proximal tibial angle (MPTA; 71.7 vs 71.8°). Children with an OCD-like lesion tended to have a lower mean body mass index (BMI; 21 vs 36, p = 0.003). Conclusion:The overall prevalence of OCD-like lesions in the medial femoral condyle in children with Blount Disease lesions is 10% using plain radiographs and at least 19% on MRI. Based on the numbers available, we were unable to demonstrate any associations between the presence of such lesions and the patient's age, gender, or magnitude of varus deformity. Further research is needed to fully ascertain the aetiology and natural history of these benign appearing osteochondral imaging findings in children with Blount Disease. Our current data support that these lesions do resolve with time and that no surgical intervention targeted at the femoral OCD-like lesion is warranted. Level of evidence:Diagnostic study Level III. How to cite this article:Edobor-Osula F, Wenokor C, Bloom T, et al. Ipsilateral Osteochondritis Dissecans-like Distal Femoral Lesions in Children with Blount Disease: Prevalence and Associated Findings. Strategies Trauma Limb Reconstr 2019;14(3):121-125.
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risk factors for failure of temporary hemiepiphysiodesis in Blount Disease a systematic review
Journal of Pediatric Orthopaedics B, 2020Co-Authors: Bensen Fan, Caixia Zhao, Sanjeev SabharwalAbstract:There is limited information regarding the use of temporary hemiepiphysiodesis for Blount Disease. We performed a systematic review of patients treated for Blount Disease using either extraperiosteal staples or plates to identify characteristics affecting clinical outcome, including the need for unplanned procedures. A total of 53 patients (63 bone segments) underwent temporary hemiepiphysiodesis at a mean age of 8.8 years (1.8-14.7 years). Overall, 32/63 (51%) segments achieved neutral mechanical axis and 31/63 (49%) underwent unplanned subsequent procedures, with or without a subsequent osteotomy. On the basis of the available heterogeneous data, neither age at index surgery nor the type of implant correlated with the need for unplanned additional surgeries.
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are patient demographics different for early onset and late onset Blount Disease results based on meta analysis
Journal of Pediatric Orthopaedics B, 2015Co-Authors: Steven Rivero, Caixia Zhao, Sanjeev SabharwalAbstract:Early-onset and late-onset Blount Disease has been described with some clinical overlap between the two forms. Using PRISMA guidelines, we searched for articles that included demographics of patients with both types of Blount Disease. On the basis of 24 articles that met our inclusion criteria, patients with early-onset Blount Disease were more likely to have bilateral involvement [odds ratio (OR) 4.30, 95% confidence interval (CI) 2.27-8.17] and less likely to be Black (OR 0.20, 95% CI 0.08-0.53) or male (OR 0.32, 95% CI 0.13-0.78). Our results confirm that differences based on laterality, race, and sex exist between the two forms of Blount Disease.
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Multiplanar deformity analysis of untreated Blount Disease
2015Co-Authors: Sanjeev Sabharwal, James Lee, Caixia ZhaoAbstract:Abstract: Although varus malalignment of the proximal tibia is the primary pathology in Blount Disease, other deformities may exist. To assess multiplanar lower limb deformities, children with previously untreated early- and late-onset Blount Disease who subsequently needed surgical correction were identified. Preoperative frontal and sagittal plane deformity analysis using Paley’s methodology and rotational profile assessment using prone clinical examination were performed by a single examiner. Results were compared between the 2 groups and with uninvolved limbs within each group. Additionally, rotational profile of the lower limb was compared with age-matched values. Over an 8-year period, 60 limbs (40 patients) including 26 with early-onset and 34 with late-onset Blount met the inclusion criteria. Although both groups exhibited proximal tibial varus, procurvatum, and internal torsion, patients with early-onset Blount Disease had greater severity. Unlike the younger patients, approxi-mately one third of the varus malalignment of the affected extremity was attributed to the distal femur in the late-onset patients. Neither group showed any significant deformity of the proximal femur and distal tibia or sagittal plane deformity of the distal femur. There was a correlation between the severity of varus malalignment of the limb with magnitude of proximal tibial deformities in both groups and with distal femoral varus in the late-onset group of patients. Multiplanar deformity analysis is a valuable tool in the comprehen-sive evaluation of children with Blount Disease
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do children with Blount Disease have lower body mass index after lower limb realignment
Journal of Pediatric Orthopaedics, 2014Co-Authors: Sanjeev Sabharwal, Sara M Sakamoto, Caixia Zhao, Emily McclemensAbstract:Background:Children with Blount Disease are typically obese. The goal of our study was to assess whether children with Blount Disease had lower body mass index (BMI) after surgical correction of their lower limb deformity.Methods:A surgical data base was used to identify children with Blount Disease
Richard J Bowen - One of the best experts on this subject based on the ideXlab platform.
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infantile tibia vara Blount Disease with iatrogenic changes causing residual tibial deformities
Journal of surgical orthopaedic advances, 2020Co-Authors: Geovanny Oleassantillan, Mihir M Thacker, Faaiza Kazmi, Theodore H Harcke, Harry Lawall, Richard J BowenAbstract:Treatment of infantile tibia vara or Blount Disease (ITV/BD) in patients < 3 years old and Langenskiold stages I-III consists of orthosis and, in relapsing cases, proximal tibial osteotomy and/or proximal tibial guided growth laterally with a tension band plate. Our aim was to evaluate the results of treatments in a consecutive group. After Institutional Review Board approval, data from 2002 to 2018 were collected. Thirty-nine knees (average age 22.4 months) with ITV/BD were treated with orthoses, and 10 knees failed. Six knees showed hyperintense T2-weighted signal in the medial proximal tibial epiphyseal cartilage on magnetic resonance imaging. Three of six knees with tibial osteotomy failed and underwent guided growth. Tibial plateau slopes were abnormal medially from the ITV/BD and laterally from the guided growth (triangular physis and depressed plateau deformities) because of factors such as orthotic treatment, tibial osteotomy, magnetic resonance imaging "physis severity score," and guided growth. (Journal of Surgical Orthopaedic Advances 29(3):141-148, 2020).
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adolescent Blount Disease in obese children treated by eight plate hemiepiphysiodesis
Eklem Hastaliklari Ve Cerrahisi-joint Diseases and Related Surgery, 2012Co-Authors: Murat Oto, Guney Yilmaz, Richard J Bowen, Mihir M Thacker, Richard W KruseAbstract:Objectives The aim of this study is to evaluate the outcomes of eight-plate (Orthofix) use during hemiepiphyseodesis operation for growth modulation in obese children with adolescent Blount Disease. Patients and methods Six limbs of five consecutive patients who underwent lateral proximal tibial eight-plate (Orthofix) hemiepiphysiodesis were evaluated. The body mass index (BMI) was >30 and the severity of the deformity was in Zone III according to the Mielke and Stevens definition. The mechanical medial proximal tibial angle (MPTA) and the mechanical axis deviation (MAD) were measured preoperatively, postoperatively, and at last follow-up. The outcome of the procedure was established by the degree of tibia vara correction degree at final plate removal or skeletal maturity. Results Mean age of the patients and mean BMI at the time of surgery was 13 years (range 12 to 14) and 33.5 kg/m2 (range 31 to 36), respectively. Patients were followed for an average of 22 months (range 13 to 31). Preoperative and last follow-up mean values for MPTA were 81 and 80 degrees, respectively. Outcome of the procedure showed two extremities demonstrated progression of the tibia vara (mean of 6.5 degrees), two extremities had no correction of the deformity, and the remaining two extremities showed minimally improvement (mean 3 degrees). The procedure failed to correct the tibia vara in all extremities and all patients were scheduled for an osteotomy to treat the deformity. Conclusion We do not recommend the use of a tension band plate hemiepiphyseodesis (eight-plate, Orthofix) to treat severe adolescent Blount Disease in obese children.
Alexander Katzman - One of the best experts on this subject based on the ideXlab platform.
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treatment of adolescent Blount Disease using taylor spatial frame with and without fibular osteotomy is there any difference
Journal of Pediatric Orthopaedics, 2015Co-Authors: Ofer Sachs, Alexander Katzman, Emad Abujohar, Mark EidelmanAbstract:Background:In adolescents, Tibia Vara (Blount Disease) patients usually present with combination of marked genu varum, procurvatum, and internal tibial torsion. When no growth remaining, standard treatment protocol for correction is osteotomy of the proximal tibia and fibula. In our study we compare
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the use of the taylor spatial frame in adolescent Blount s Disease is fibular osteotomy necessary
Journal of Children's Orthopaedics, 2008Co-Authors: Mark Eidelman, Viktor Bialik, Alexander KatzmanAbstract:Background The standard treatment of adolescent Blount Disease includes proximal tibial osteotomy and osteotomy of the fibula. Some believe that the fibula should also be fixed to prevent migration and subluxation. The purpose of the current study was to examine the results of treatment of patients with adolescent tibia vara treated by tibial osteotomy and Taylor spatial frame (TSF) without fibular osteotomy.
Geovanny Oleassantillan - One of the best experts on this subject based on the ideXlab platform.
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infantile tibia vara Blount Disease with iatrogenic changes causing residual tibial deformities
Journal of surgical orthopaedic advances, 2020Co-Authors: Geovanny Oleassantillan, Mihir M Thacker, Faaiza Kazmi, Theodore H Harcke, Harry Lawall, Richard J BowenAbstract:Treatment of infantile tibia vara or Blount Disease (ITV/BD) in patients < 3 years old and Langenskiold stages I-III consists of orthosis and, in relapsing cases, proximal tibial osteotomy and/or proximal tibial guided growth laterally with a tension band plate. Our aim was to evaluate the results of treatments in a consecutive group. After Institutional Review Board approval, data from 2002 to 2018 were collected. Thirty-nine knees (average age 22.4 months) with ITV/BD were treated with orthoses, and 10 knees failed. Six knees showed hyperintense T2-weighted signal in the medial proximal tibial epiphyseal cartilage on magnetic resonance imaging. Three of six knees with tibial osteotomy failed and underwent guided growth. Tibial plateau slopes were abnormal medially from the ITV/BD and laterally from the guided growth (triangular physis and depressed plateau deformities) because of factors such as orthotic treatment, tibial osteotomy, magnetic resonance imaging "physis severity score," and guided growth. (Journal of Surgical Orthopaedic Advances 29(3):141-148, 2020).