Guided growth for valgus deformity correction of knees in a girl with osteopetrosis: a case report

Autosomal dominant osteopetrosis (Albers-Schönberg disease) classically displays the radiographic signs of osteosclerosis. The main ADO complications involve the skeleton: low-impact bone fractures, scoliosis and hip osteoarthritis. Management of osteopetrosis-related orthopedic problems is a surgical challenge due to increased bone density. The healing process is very slow in these patients because of bone remodeling defects related to osteoblast function failure. In case of bone deformities, a realignment method should be appropriated to osteopetrosis conditions. This article presents a case report of operative treatment of an 11-year-old girl affected with ADO, who underwent a simultaneous valgus knee deformity correction of both limbs with medial eight-plate epiphysiodesis. Simultaneous correction of valgus deformity on both limbs using an extraperiosteal tension plate technique for medial tibial hemiepiphysiodesis was performed in a girl of 11.5 years old with autosomal dominant osteopetrosis. The treatment duration from surgery to complete deformity correction and removal of plates was 18 months. The final aMPTA was 86° on the right side and 85° on the left side. The correction rate was 0.61°/month (right tibia) and 0.67°/month (left tibia). The MAD correction rate was evaluated as 1.5 mm/month for the right limb and 1.6 mm/month for the left limb. At the moment of plate removal, one screw was broken because of tight fixation in osteopetrotic bone. But it did not compromise the final result. The latest follow-up visit at the age of 14 years 6 months revealed excellent realignment without any deformity relapse. There was no any functional impairment. We consider the guided growth by tension band technique as very interesting and promising solution for treatment of pediatric angular deformity in patients with OP. This method allows to avoid osteotomy and related important risk of delayed union or nonunion frequently observed in osteopetrosis. LEVEL OF EVIDENCE Level IV.