The Outcomes of Guided Growth System in Juvenile and Adolescent Patients With Blount Disease

Oct 21, 2026

Guided growth offers a less invasive treatment option for Blount disease, particularly for juvenile and adolescent patients with more severe mechanical axis deviation (MAD). This study analyzed patients older than 4 years treated from January 2005 to September 2023, defining success as correction to MAD zones −1, 0, or +1 using guided growth alone, while failure included persistent non-correction or need for osteotomy. Outcomes, odds ratios, and risk comparisons were evaluated for risk factors and implant constructs.

LanguageEnglish

CategoryHealthcare

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Pages6

Reading Time15 min

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The Outcomes of Guided Growth System in Juvenile and Adolescent Patients With Blount Disease Ergin Coskun, MD,* Laura E. Bess, MD,† and Robert J. Bielski, MD† Background: Guided growth offers a less invasive option for the treatment of Blount disease. Previous studies have found guided growth to be much less successful for individuals with more severe mechanical axis deviation (MAD) . This study aims to assess the effectiveness and safety of guided growth systems for treating Blount disease in juvenile and adolescent patients with particular attention to patients presenting with severe deformities. Methods: Patients were included if greater than 4 years of age and had undergone guided growth from January 2005 to September 2023 . Treatment success was deﬁned as ﬁnal correction to MAD zone −1, 0, or +1 using only guided growth. Failure was deﬁned as individuals who did not achieve correction to the above zones or those requiring osteotomy. Odds ratios were calculated for failure in patients with initial presentation in MAD zones −3 and −4 . To further analyze our results, we also compared the treatment success rate of the 4-screw construct versus 2-screw construct, both of which are used at our institution. Results: A total of 32 patients with 44 extremities were included in this study: 13 patients (41%) in the juvenile group, and 19 patients (59%) in the adolescent group. Overall, successful correction to MAD −1, 0, and +1 was 61% . Factors associated with failure were mean BMI 40.3 (±8.8) versus 33.5 (±9.3),(P = 0.034) . The odds ratio of zone –3 and zone −4 deformity treatment failure were 1.64 (95% CI: 0.48-5.56) and 1.78 (95% CI: 0 .51-6. 17), respectively. The relative risk of 4-screw plate construct for treatment failure was 0.5 (95% CI: 0.21-1.19) while 2-screw plate construct carried a relative risk of 4.5 (95% CI: 0.579-35.6) for mechanical implant failure. Conclusions: Our research demonstrates that moderate and severe varus deformity (zone −3 and −4) in children with Blount disease can be successfully treated by tension band plating, though the failure rate still remains high. Level of Evidence: Level III. From the *Pediatric Orthopaedic Surgery, Arnold Palmer Hospital for Children, Orlando Health, Orlando, FL; and †Pediatric Orthopaedic Surgery, Riley Hospital for Children, Indiana University Health, Indianapolis, IN. No funding was received for this project. The authors declare no conﬂicts of interest. Reprints: Robert J. Bielski, MD, Pediatric Orthopaedic Surgery, Riley Hospital for Children, Indiana University Health, Indianapolis 46202, IN. E-mail: [rbielski@iuhealth.com](rbielski@iuhealth.com). DOI: 10.1097/BPO.0000000000003149 [166](166 | www.pedorthopaedics.com)[ |](166 | www.pedorthopaedics.com)[ www.pedorthopaedics.com](166 | www.pedorthopaedics.com) Key Words: blount disease, tibia vara, guided growth system, hemiepiphysiodesis, tension band plating, eight-plate (J Pediatr Orthop 2026;46:166–171) Blount disease, also known as pathologic tibia vara, is a varus deformity resulting from growth inhibition of the medial aspect of the proximal tibial physis. 1,2 It isclassiﬁed as infantile if the deformity appears before the age of 4, juvenile between the ages of 4 and 10, and adolescent after the age of 10 .2–4 In assessing the severity of Blount disease, a standardized measurement system has been used in previous studies by McIntosh et al5 and Park et al.3 The knee is radiographically divided into 4 quadrants with the midpoint designated as zero (Fig. 1 A-B) .3 The physiological mechanical axis passes through the central 2 quadrants; zones –1 and +1 .5 The medial deviation of the axis beyond the central zone is deﬁned as pathologic genu varum. While zone –2 indicates mild deformity, zones –3 and –4 indicate moderate and severe deformities, respectively.3,5 Surgical treatment options for Blount disease includes corrective osteotomies and guided growth systems, including hemiepi

FAQs

How was treatment success defined in this study?

Success required final correction to MAD zones −1, 0, or +1 using only guided growth. Failure included lack of correction to these zones or the need for osteotomy.

What patient age range and treatment period were included?

Patients were older than 4 years at presentation and received guided growth between January 2005 and September 2023.

Which factors were associated with treatment failure?

Higher mean BMI was associated with failure (40.3 ± 8.8 vs 33.5 ± 9.3; P = 0.034). The study also examined odds ratios for more severe initial deformity zones −3 and −4.

Oct 21, 2026

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