Outcome of Different Surgical Techniques for Management of Adolescent Tibia Vara; Systematic review

Document Type : Review Article

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Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Abstract

Background: Adolescent tibia vara [ATV] is a multiplanar malformation that can cause diminished function and permanent damage. ATV is believed to be a multifaceted developmental disease of the proximal tibia, which results in a malformation of the varus and procurvatum. In genetically vulnerable individuals, this disorder may also be partially attributed to mechanical strain.
The Aim of the work: This pooled analysis goal is to evaluate and compile the data about the efficacy and complications of the most popular surgical lines of treatment of tibia vara in adolescents: osteotomy, Ilizarov, and hemiepiphysiodesis.
Methods: Considering the search strategy, a literature study was conducted from 2010 to 2020 in the Web of Science, PubMed, Scopus, and Cochrane datasets. Studies were selected if it included. This systematic review had 15 published papers with a total sample size of 357 limbs.
Results: Temporal hemiepiphysiodesis is used effectively to treat mild/moderate ATV in patients with sufficient growth. Temporal hemiepiphysiodesis has been linked to an elevated failure and recurrence rate of approximately 28.4%. In managing ATV, a modified Rab osteotomy with minimal fixation using two or three screws yields encouraging outcomes. However, the post-operative time of healing is affected by BMI. Thus, it's not the best choice for obese patients with ATV. For correcting mild to moderate ATV, medial opening wedge high tibial osteotomy—with or without a bone graft—is an appropriate approach.
Conclusion: The best surgical technique for adolescent tibia vara depends on the patient's circumstances. Osteotomy is generally preferred over hemiepiphysiodesis due to its lower recurrence rate. The use of simple circular frame fixation with proximal tibial osteotomy is the ideal option for treating neglected ATV, mainly when the patient is obese and has severe deformities.

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