Implant-Mediated Guided Growth for Coronal Plane Angular Deformity in the Pediatric Patient with Patellofemoral Instability

Abstract

Pediatric patellofemoral instability is a complex problem, for which there are several anatomic risk factors. Coronal plane malalignment (i.e., genu valgum) is one cause of patellofemoral instability, and treatment of genu valgum has been associated with improved patellofemoral stability. Coronal plane angular deformity correction, typically achieved by distal femoral osteotomy in the adult population, can be achieved with less invasive surgical techniques in pediatric patients using implant-mediated guided growth. By temporarily tethering one side of an open physis to generate differential growth in the coronal plane, valgus malalignment can be corrected. We present our technique for medial distal femoral implant-mediated guided growth using tension band plating for treatment of pediatric patellofemoral instability associated with genu valgum. This technique is minimally invasive, has a low complication rate, and in conjunction with conventional treatment can reduce the risk of recurrent instability.