Most Coronal Knee Deformities of Healed Nutritional Rickets Under 8 Years of Age Remodel Spontaneously: Building Evidence for Practice Change.

IF 1.5 3区 医学 Q3 ORTHOPEDICS
Journal of Pediatric Orthopaedics Pub Date : 2025-10-01 Epub Date: 2025-07-03 DOI:10.1097/BPO.0000000000003028
Mostafa M Baraka, Shady Samir, Shady Mahmoud, Tamer A El-Sobky
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Abstract

Background: Nutritional rickets remains a global health burden. The optimal management of coronal knee deformities in children/adolescents with healed nutritional rickets as to the indications of conservative treatment versus guided growth surgery remains unsettled. The objective was to report the natural history of disease regarding the remodeling potential of coronal knee deformities and isolate potential patient- and deformity-related factors that are predictors of favorable deformity remodeling.

Methods: We prospectively assessed 109 knees in 57 patients-mean age, 6.1 years (range, 2 to 12)-for spontaneous correction of their coronal knee deformities over a period of 1 year. Male/female:33/24, valgum/varum:34/23, bilateral/unilateral:52/5 patients. Outcome variables were, radiologic tibiofemoral angle and a questionnaire to assess parent satisfaction. They were correlated to independent patient- and deformity-related variables, including age, sex, deformity direction/severity, and laterality.

Results: The mean age of patients that achieved complete knee remodeling (4.9 y) was significantly lower compared with patients who experienced complete failure of remodeling (8.4 y), P =0.000, (95% CI, 4.3-5.4). In 109 knees, there was a highly significant negative Spearman correlation coefficient between age and degrees of coronal correction, patient satisfaction, and complete failure of remodeling R=-0.660, R=-0.475, R=-0.434, respectively, P <0.001. The knees of patients >8 years of age that failed to remodel (87.5%) was significantly higher compared with patients ≤8 years (29.9%), P =0.000, OR=16.4, (95% CI, 5.2-52.2). There were statistically significant correlations between deformity severity/tibiofemoral angle and the remodeling potential, with a cutoff angle of 16.5 degrees/13 degrees for valgum/varum above which deformities were less likely to remodel spontaneously, P =0.03, P =0.007. Complete knee remodeling in unilateral deformities was statistically but not clinically significant. Correlations of sex and deformity direction with remodeling outcomes were insignificant. The inter- and intrarater agreements were excellent for the radiologic tibiofemoral angle measurements (ICC=0.993, CI, 0.982-0.997, P  <0.01) and (ICC=0.994, CI, 0.987-0.998, P <0.01), respectively.

Conclusion: Children with coronal knee deformities of healed nutritional rickets under the age of 8 years should be given the full opportunity to remodel spontaneously for at least 1 year, particularly children with moderate deformities ≤16 degrees. This is irrespective of sex, deformity direction, and laterality. Most deformities remodel spontaneously. This suggests that these deformities may be overtreated. This could reduce unnecessary surgeries and potentiate cost-effectiveness of treatment and risk-benefit profile.

Level of evidence: Level IV prognostic studies-investigating the effect of a patient characteristic on the outcome of disease.

大多数8岁以下营养性佝偻病愈合后的冠状膝关节畸形自发重塑:实践改变的证据。
背景:营养性佝偻病仍然是全球健康负担。对于营养性佝偻病治愈的儿童/青少年冠状膝关节畸形的最佳治疗方法,保守治疗与引导生长手术的适应症仍未确定。目的是报告关于冠状膝关节畸形重塑潜力的疾病自然史,并分离潜在的患者和变形相关因素,这些因素是有利的畸形重塑的预测因素。方法:我们前瞻性评估了57例患者的109个膝关节,平均年龄6.1岁(范围2至12岁),在1年的时间内对其冠状膝关节畸形进行自发矫正。男/女:33/24,外翻/内翻:34/23,双侧/单侧:52/5。结果变量为放射学胫股角度和家长满意度问卷。它们与独立的患者和畸形相关变量相关,包括年龄、性别、畸形方向/严重程度和侧边。结果:完成完全膝关节重塑的患者平均年龄(4.9岁)明显低于完全重塑失败的患者(8.4岁),P=0.000, (95% CI, 4.3-5.4)。109个膝关节中,年龄与冠状面矫正程度、患者满意度、重塑完全失败的Spearman负相关系数分别为R=-0.660、R=-0.475、R=-0.434,重塑失败的P8岁患者(87.5%)明显高于≤8岁患者(29.9%),P=0.000, OR=16.4, (95% CI, 5.2 ~ 52.2)。畸形严重程度/胫股角与重塑潜力之间存在统计学意义上的相关性,外翻/内翻的截断角为16.5°/13°,以上的畸形不容易自发重塑,P=0.03, P=0.007。单侧畸形患者完全膝关节重塑有统计学意义,但无临床意义。性别和畸形方向与重塑结果的相关性不显著。结论:8岁以下营养性佝偻病已愈合的冠状膝关节畸形患儿应给予至少1年的充分机会进行自发重建,尤其是中度畸形≤16度的患儿。这与性别、畸形方向和侧面无关。大多数畸形是自发重塑的。这表明这些畸形可能被过度治疗了。这可以减少不必要的手术,提高治疗的成本效益和风险效益。证据水平:IV级预后研究——调查患者特征对疾病结局的影响。
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来源期刊
CiteScore
3.30
自引率
17.60%
发文量
512
审稿时长
6 months
期刊介绍: ​Journal of Pediatric Orthopaedics is a leading journal that focuses specifically on traumatic injuries to give you hands-on on coverage of a fast-growing field. You''ll get articles that cover everything from the nature of injury to the effects of new drug therapies; everything from recommendations for more effective surgical approaches to the latest laboratory findings.
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