Assessing Knee Stability in Adolescent Athletes with Osgood-Schlatter Disease Using the Y-Balance Test.

PURPOSE OF THE STUDY Osgood-Schlatter disease develops secondary to chronic patellar tendon overloading. The present study was designed to determine whether athletes with Osgood-Schlatter disease perform significantly worse in the Y-Balance Test compared to healthy subjects in a control group. MATERIAL AND METHODS The study involved ten boys (average age 13.7 years). Seven participants had bilateral knee pain, swelling and tenderness whereas three had unilateral knee pain, swelling and tenderness (left knee in two cases, and right knee in one). Overall, 17 knees were assessed (left knee in nine cases and right knee in eight).Ten healthy adolescent professional football players (mean age 14.6 years) were selected as a control group. In both groups, complex knee stability was assessed using the Y-Balance Test and their data were analyzed using the methodology developed by Plisky et al. The test outcome was expressed in indexed (normalized) values for the right and left lower extremities, and averaged values for the individual directions were compared. RESULTS Significant differences between both groups were shown in the posteromedial and posterolateral directions. CONCLUSIONS Using the Y-Balance Test, our study documented reduced performance in the above directions in patients with OsgoodSchlatter disease. Key words: Osgood-Schlatter disease, knee, balance test, movement patterns patellar tendon overload.

Osgood-Schlatter disease: a 2020 update of a common knee condition in children.

PURPOSE OF REVIEW: Osgood-Schlatter disease (OSD) is one of the most common causes for anterior knee pain in children and adolescents resulting from a traction apophysitis of the tibial tubercle. While a peak in boys aged 12-15 years old was well documented, there seems to be no difference in sex distribution nowadays. This may result from increased participation of young females in high-impact sports. This review provides an up-to-date account on contemporary prophylaxis as well as diagnostic and therapeutic approaches. RECENT FINDINGS: Numerous studies have examined risk factors for OSD. These include body weight, muscle tightness, muscle weakness during knee extension and flexibility of hamstring muscles. In particular, shortening of the rectus femoris may substantially alter biomechanical functions of the knee. Conservative management remains successful in over 90% of patients. However, if disabling symptoms and pain persistent after physeal closure, operative treatment may be necessary. SUMMARY: OSD is a mostly self-limiting apophysitis of the tibial tubercle and the adjacent patella tendon in young active patients with open physis. Prevention strategies include quadriceps and hamstring stretching and therefore should be implemented in everyday practice routines for children who partake in regular sports activities.

Current management strategies in Osgood Schlatter: A cross-sectional mixed-method study.

BACKGROUND: Osgood Schlatter disease (OSD) is the most common knee condition in adolescent athletes aged 9-16. Without evidence to guide clinical practice, it is unclear how OSD is managed. The aim of this study was to investigate how international healthcare professionals (general practitioners, physiotherapists, rheumatologists, sports and exercise medicine doctors, and orthopedic surgeons) diagnose and manage OSD. METHODS: This mixed-method study used a convergent parallel design. A quantitative questionnaire and semi-structured interview covered prognosis, diagnosis, treatment, and return to play of adolescents with OSD. For quantitative data, those who reported likely/very likely considered "for" and unlikely/very unlikely "against" (for specific diagnostic/management strategy). Qualitative data analysis used a phenomenological approach. RESULTS: Two hundred and fifty-one healthcare professionals completed the questionnaire. The most common diagnostic criterion was pain at the tibial tuberosity (97% for). The most common treatments were patient education (99%) and exercise therapy (92%). Other treatment options were more heterogeneous, for example, pain medication (31% for and 34% against). Managing training load (97%), pain intensity (87%), and psychological factors (86%) were considered the most important factors influencing the return to activities. Several themes emerged from the interviews (on N = 20) including imaging, pain management, family, and psychosocial factors influencing prognosis. CONCLUSION: Diagnosis criteria of OSD were relatively well agreed upon, whereas the triangulation of qualitative and quantitative data showed heterogeneity of treatments. Psychosocial factors including family were highlighted as critical in the management of OSD.

The Passive Mechanical Properties of Muscles and Tendons in Children Affected by Osgood-Schlatter Disease.

BACKGROUND: Osgood-Schlatter disease (OSD) is a sports-related disorder involving apophysitis, which affects the tibial tuberosity. The identification of factors related to OSD is important for its prevention and early recovery from the disease. This study aimed to compare the passive mechanical properties of the muscle-tendon unit in children affected by an OSD and healthy children, by using ultrasound real-time tissue elastography. METHODS: Eighteen legs affected by OSD (OSD group) and 42 healthy legs (control: CON group) were assessed. The elasticity was obtained from the quadriceps muscles and patella tendon (PT) using real-time tissue elastography. The strain ratio (SR; muscle or tendon/reference ratio: strain rate of the muscle or tendon divided by that of the reference material) was calculated as an indicator of the elasticity of the tissue of interest. RESULTS: The SR of the PT in the OSD group was significantly lower than that in the CON group (P<0.05). We found no significant difference between the groups in terms of the SR value of all muscles (P>0.05). CONCLUSIONS: The results suggest that a PT with a lower SR may be associated with an OSD and that the passive mechanical properties of the quadriceps muscles have limited association with an OSD. LEVELS OF EVIDENCE: Level IV.

Arthroscopic Treatment of Osteochondral Lesions of the Talus Utilizing Juvenile Particulated Cartilage Allograft: A Case Series.

The treatment options for osteochondral lesions of the ankle are scarce, and newer modalities are becoming available. We describe a minimally invasive arthroscopic approach with implantation of juvenile particulated allograft to facilitate the growth of true hyaline cartilage in patients with osteochondral lesions of the talus. The purpose of this study was to subjectively review clinical outcomes using the validated Foot and Ankle Outcomes Score in patients who underwent this technique. Our technique was performed on 82 consecutive patients with average follow-up of 24 (range 9 to 86) months. We found that 28 (88%) of 32 patients who responded to the questionnaire had good or excellent results for activities of daily living; 26 (82%) of 32 patients had at least a good result for both pain and symptoms; and 25 (78%) of 32 had at least a fair result for functional sports and quality of life.

Vascularized Medial Femoral Condyle Autografts for Osteochondral Lesions of the Talus: A Preliminary Prospective Randomized Controlled Trial.

Talar osteochondral lesions (OCLs) lead to progressive stages of talar destruction. Core decompression with cancellous bone grafting (CBG) is a common treatment for Berndt and Harty stages II and III. However, in a subset of patients, talar revascularization may fail. Surgical angiogenesis using vascularized medial femoral condyle (MFC) autografts may improve on these outcomes. These 2 treatment strategies were directly compared via a prospective preliminary randomized trial including 20 participants with talar core decompression followed by either cancellous (CBG group, n = 10) or vascularized MFC (MFC group, n = 10) bone grafting. Outcome analysis was performed with visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Lower Extremity Functional Scale (LEFS), and contrast-enhanced magnetic resonance imaging (MRI) scans. At 12 months of follow-up, the mean VAS score was reduced from 6.6 ± 2.5 preoperatively to 4 ± 1.9 in the CBG group and from 5.2 ± 2.9 preoperatively to 1 ± 1.1 in the MFC group (p < .001). The LEFS improved from 53.4 ± 13.1 to 62.6 ± 16.2 CBG and from 53 ± 9.3 to 72.4 ± 7.4 MFC (p = .114). AOFAS improved from 71 ± 12.1 to 84.1 ± 12.5 in CBG and from 70.5 ± 7.4 to 95.1 ± 4.8 in MFC (p = .019). The MRI scans in the CBG group demonstrated 9 partial malperfusions and 1 hypervascularized bone graft, whereas the MFC group had 8 well-vascularized grafts incorporated into the talus and 1 partial malperfusion. Vascularized MFC autografts provide superior pain relief along with improvement of physical function in patients with talar OCL stage II and III compared with CBG. To confirm these promising results, further multicenter randomized controlled trials are required.

Recurrence After Surgical Intervention for Infantile Tibia Vara: Assessment of a New Modified Classification.

BACKGROUND: To propose a modified classification of infantile tibia vara based on the morphology of the metaphyseal/epiphyseal tibial slope that better correlates with treatment outcomes than the traditional Langenskiold classification. METHODS: We performed a retrospective review of 82 patients and 115 limbs that underwent surgery for infantile tibia vara over a 22-year period (1990 to 2012) at a single institution. A modified Langenskiold classification was applied to all patients preoperatively and the outcomes were assessed. The modified system created a 3-stage classification (types A, B, and C): type A has a partially lucent medial metaphyseal defect, with or without "beaking"; type B deformity has downward-sloping curvature of the lateral and inferior rim of a completely lucent metaphyseal defect, which then has an upslope at the medial rim, resembling a ski-jump, with no epiphyseal downward slope; type C has vertical, downsloping deformity of both the epiphysis and metaphysis, with no upward curvature projecting medially at the inferior extent, while the epiphysis slopes downward into the metaphyseal defect. RESULTS: Sixty-seven limbs did not develop recurrence following corrective osteotomy, whereas 48 limbs required at least 1 repeat surgery for recurrent deformity. Preoperative mechanical axis deviation, medial proximal tibial angle, lateral distal tibial angle, and body mass index did not differ significantly between those with recurrence and those with without. Mean age at surgery was significantly different for those who developed recurrence compared with those who did not. Patients without recurrence were 4.3 years of age (range, 2.4 to 10.3 y) compared with 6.2 years of age (range, 2.9 to 10.1 y) for those who recurred (P<0.01). Of patients who developed recurrent deformity, there were significantly more patients with type C changes (71.7%, P<0.01) then either type A (22.5%) or type B (20.7%). High rates of recurrence were seen for both Langenskiold stage III (50%) and stage IV (69.6%). CONCLUSIONS: Consistent with prior studies, age 5 seems to be a critical transition in the risk for recurrent deformity after tibial osteotomy. Extreme vertical sloping of the medial metaphyseal defect, as in some classic Langenskiold III lesions and more precisely described by type C in a newer, modified classification, carries a poor prognosis for successful correction by high tibial osteotomy alone or in combination with epiphysiolysis. LEVEL OF EVIDENCE: Level II.

Synovial Fluid Metabolites Differentiate between Septic and Nonseptic Joint Pathologies.

Osteoarthritis (OA), osteochondrosis (OC), and synovial sepsis in horses cause loss of function and pain. Reliable biomarkers are required to achieve accurate and rapid diagnosis, with synovial fluid (SF) holding a unique source of biochemical information. Nuclear magnetic resonance (NMR) spectroscopy allows global metabolite analysis of a small volume of SF, with minimal sample preprocessing using a noninvasive and nondestructive method. Equine SF metabolic profiles from both nonseptic joints (OA and OC) and septic joints were analyzed using 1D 1H NMR spectroscopy. Univariate and multivariate statistical analyses were used to identify differential metabolite abundance between groups. Metabolites were annotated via 1H NMR using 1D NMR identification software Chenomx, with identities confirmed using 1D 1H and 2D 1H 13C NMR. Multivariate analysis identified separation between septic and nonseptic groups. Acetate, alanine, citrate, creatine phosphate, creatinine, glucose, glutamate, glutamine, glycine, phenylalanine, pyruvate, and valine were higher in the nonseptic group, while glycylproline was higher in sepsis. Multivariate separation was primarily driven by glucose; however, partial-least-squares discriminant analysis plots with glucose excluded demonstrated the remaining metabolites were still able to discriminate the groups. This study demonstrates that a panel of synovial metabolites can distinguish between septic and nonseptic equine SF, with glucose the principal discriminator.

Is Legg-Calvé-Perthes Disease a Local Manifestation of a Systemic Condition?

BACKGROUND: Osteochondrosis includes numerous diseases that occur during rapid growth, characterized by disturbances of endochondral ossification. One example, Legg-Calvé-Perthes disease, is characterized by disruption of the blood supply to the femoral head epiphysis, and a systemic etiology often has been suggested. If this were the case, secondary osteochondroses at locations other than the hip might be expected to be more common among patients with Legg-Calvé-Perthes disease, but to our knowledge, this has not been evaluated in a nationwide sample. QUESTIONS/PURPOSES: (1) Do patients with Legg-Calvé-Perthes disease have an increased prevalence of secondary osteochondroses at locations other than the hip? (2) Is the concept of Legg-Calvé-Perthes disease a systemic etiology supported by a higher prevalence of the metabolic diseases obesity and hypothyroidism? METHODS: We designed a retrospective population-based cohort study with data derived from the Swedish Patient Registry (SPR). The SPR was established in 1964 and collects information on dates of hospital admission and discharge, registered diagnoses (categorized along the International Classification of Diseases [ICD]), and applied treatments during the entire lifetime of all Swedish citizens with high validity. Analyzing the time span from 1964 to 2011, we identified 3183 patients with an ICD code indicative of Legg-Calvé-Perthes disease and additionally sampled 10 control individuals per patient with Legg-Calvé-Perthes disease, matching for sex, age, and residence, resulting in 31,817 control individuals. The prevalence of secondary osteochondroses, obesity, and hypothyroidism was calculated separately for patients with Legg-Calvé-Perthes disease and control individuals based on the presence of ICD codes indicative of these conditions. Using logistic regression analysis, we compared the adjusted relative risk of having either of these conditions develop between patients with Legg-Calvé-Perthes disease and their matched control subjects. The mean followup was 26.1 years (range, 2.8-65 years). RESULTS: The prevalence of secondary osteochondroses was greater among patients with Legg-Calvé-Perthes disease (3.11%) than among control subjects (0.31%), resulting in an increased adjusted risk of an association with such lesions in the patients (relative risk [RR], 10.3; 95% confidence interval [CI], 7.7-13.6; p < 0.001). When stratified by sex, we attained a similarly increased risk ratio for females (RR, 12.5; 95% CI, 6.1-25.8; p < 0.001) as for males (RR, 9.9; 95% CI, 7.3-13.5; p < 0.001). Patients with Legg-Calvé-Perthes disease had an increased adjusted risk of an association with obesity (RR, 2.8; 95% CI, 1.9-4.0; p < 0.001) or hypothyroidism (RR, 2.6; 95% CI, 1.7-3.8; p < 0.001) when compared with control subjects. CONCLUSIONS: To our knowledge, this is the first population-based description of a robust association of Legg-Calvé-Perthes disease with osteochondroses at locations other than the hip, and we also found increased risk estimates for an association with obesity and hypothyroidism in patients with Legg-Calvé-Perthes disease. Our findings strengthen the hypothesis that Legg-Calvé-Perthes disease is the local manifestation of a systemic disease, indicative of an underlying common disease pathway that requires further investigation. Physicians should be aware that patients with Legg-Calvé-Perthes disease may present with secondary osteochondroses and metabolic comorbidities. LEVEL OF EVIDENCE: Level III, prognostic study.

Common paediatric conditions of the lower limb.

Growing children are susceptible to a number of disorders to their lower extremities of varying degrees of severity. The diagnosis and management of these conditions can be challenging. With musculoskeletal symptoms being one of the leading reasons for visits to general practitioners, a working knowledge of the basics of these disorders can help in the appropriate diagnosis, treatment, counselling, and specialist referral. This review covers common disorders affecting the hip, the knee and the foot. The aim is to assist general practitioners in recognising developmental norms and differentiating physiological from pathological conditions and to identify when a specialist referral is necessary.

Guided Growth Implant Failure is a Result of Cyclic Fatigue: Explant Analysis With Scanning Electron Microscopy.

BACKGROUND: Guided growth is often used to correct limb deformity and yet implant screw failure in modular systems has been reported. There have been no reports of plate failure and we do not know the exact mode of failure when screws do break. METHODS: We report the first published case of a fractured plate in a modular plate and screw construct that was used to correct Blount disease in a child through guided growth. The implants were removed and analyzed for method of failure using scanning electron microscopy. RESULTS: Scanning electron microscopy of the explant confirms that the mode of failure was not a result of static tension from growth. Rather, analysis confirms cyclic fatigue that led to crack propagation across the anterior side of the plate until overload caused complete plate failure. CONCLUSIONS: This analysis confirms an in vivo cyclic compression-relaxation of the growth plate presumably to weight-bearing, and that when excessive may lead to implant failure as seen here in this case. LEVEL OF EVIDENCE: Level V.

An Osteochondral Lesion of the Distal Tibia and Fibula in Patients With an Osteochondral Lesion of the Talus on MRI: Prevalence, Location, and Concomitant Ligament and Tendon Injuries.

OBJECTIVE: The purpose of this study was to evaluate the prevalence and common location of a coexisting osteochondral lesion of the distal tibia and fibula and of associated abnormalities of the ankle ligaments and tendons on MRI in patients with an osteochondral lesion of the talus (OLT). MATERIALS AND METHODS: A search of a database of MRI studies performed between July 2003 and January 2014 yielded MRI examinations of 297 feet with OLTs. Two readers reviewed the MRI examinations independently for the presence of an osteochondral lesion of the distal tibia and fibula and for concomitant ligament and tendon injuries. If an osteochondral lesion of the distal tibia and fibula was present, the reviewers also recorded the location (zones 1-10) and stage. Interobserver and intraobserver reliabilities were assessed using kappa statistics. The associations between a coexisting osteochondral lesion of the distal tibia and fibula and an OLT or a concomitant ankle injury were evaluated using the chi-square test. RESULTS: Readers A and B identified 61 (20.5%) and 47 (15.8%) coexisting osteochondral lesions of the distal tibia and fibula, respectively, with good interobserver (κ = 0.73) and excellent intraobserver (κ = 0.97) reliabilities. The most common location of a coexisting osteochondral lesion of the distal tibia and fibula was zone 4 (29.5%) by reader A and zone 2 (21.3%) by reader B. Stage I and stage IIA were common (> 85%). The frequency of osteochondral lesions of the distal tibia and fibula was not significantly different according to the location or stage of OLT. Abnormalities in the tibialis posterior tendon and in the anterior and posterior talofibular, calcaneofibular, and deltoid ligaments were significantly more common in patients with a coexisting osteochondral lesion of the distal tibia and fibula than in those with an isolated OLT (p < 0.05). CONCLUSION: A coexisting osteochondral lesion of the distal tibia and fibula is not rare on MRI in patients with an OLT and is related to a higher frequency of concomitant ankle ligament and tendon injuries.

A longitudinal study on the performance of in vivo methods to determine the osteochondrotic status of young pigs.

BACKGROUND: In today's porcine industry, lameness has a major welfare and economic impact, and is often caused by osteochondrosis (OC). The etiological factors of the disease have been studied in depth, however, to this day, little is known about the natural course of the disorder and how it can be detected at an early stage in pigs. The aim of this pilot study was to assess the potential of three non-invasive techniques for the detection and monitoring of early OC processes in piglets. A group of weaned piglets (n = 19) were examined longitudinally using radiographs, a visual lameness scoring scheme and a quantitative pressure-mat based locomotion analysis system to detect OC in the humeroradial, femoropatellar and tarsocrural joints. At several time points, a selection of animals was euthanized for post-mortem examinations, including histology, which was the gold standard. RESULTS: In this study, clear signs of subclinical signs of OC were observed, however, we were unsuccessful in producing clinical OC. Lesions were observed to be commonly bilaterally symmetric in the joints examined in 80% of cases. The radiographic examinations showed a clear correlation with the gold standard, particularly when subclinical lesions were of a high histological score. Moreover, radiography was also able to detect the early repair processes, which appeared to take place at least until 14 weeks of age. Both visual scoring and pressure mat analyses showed good intra-assay reproducibility, with the pressure mat showing intra-class correlation values between 0.44 and 0.6 and the inter-observer agreement of visual scoring method was between 88 and 96%, however their correlation to OC lesions detected by histology was very weak, with only 2 out of 12 traits for the visual scoring method showing significant and biologically logical relations to a specific joint having histological OC lesions. For the pressure mat, only a maximum of 5 associations for specific joints with histological OC lesions were found out of a possible 8. CONCLUSION: All tested in-vivo methods showed good reproducibility. Radiography was the most reliable technique to detect and monitor longitudinally the earliest signs of OC in these piglets. It also demonstrated that the "Point of No Return" (PNR) of the disease, when repair processes end, might be later than anticipated, after 13 weeks of age. All in all, our study shows that the timing of the use of these in-vivo methods is critical to detect and monitor OC, especially in the early phases of the disease. It also shows the difficulty in producing OC regardless of the optimization of the experimental settings in relation to the etiological factors known to induce OC.

[Clinical examination, imaging and therapy of Osgood-Schlatter's disease]. / Klinik, Bildgebung und Therapie des Morbus Osgood-Schlatter.

BACKGROUND: Osgood-Schlatter's disease represents an often seen painful knee illness of temporary duration in adolescent sportsmen, caused by severe stress to the tibial apophysis. RESULTS: A study in 29 consecutive patients (∅ 12,7 yrs, 77 % male, 67 % non-dominant side affected, 4 patients both knee joints affected, always pain after performance, high sports activity in football, basketball, gymnastics/ballett, 41 % shortening of m. rectus fem.) shows that pure clinical diagnosis is sufficient. DISCUSSION: Imaging is only necessary in case of suspected concurrent origin, as it does not yield unique results and does not support therapy nor prognosis. Patients reduce their performance on their own. Late pain occurs at the apophyseal protuberance due to local compression. Restrictive recommendations to patients to leave their sport activity are not justified.

OSTEOCHONDROSIS IN THE DISTAL FEMURS OF AN ADULT RETICULATED GIRAFFE (GIRAFFA CAMELOPARDALIS RETICULATA): MACROSCOPIC, RADIOLOGIC, AND HISTOLOGIC FINDINGS.

An adult male reticulated giraffe (Giraffa camelopardalis reticulata) was presented for postmortem examination. During radiologic examination of the hindlimbs, osseous cyst-like lesions were detected in both medial femoral condyles. These lesions were subsequently examined macroscopically and histologically. The gross appearance suggested a diagnosis of bilateral osteochondrosis that was confirmed with histopathologic examination. This finding has not previously been reported in giraffes. Macroscopic visualization of the major limb joints, including the femorotibial joints, is therefore encouraged in future postmortem examinations of giraffes (Giraffa camelopardalis), and further assessment of clinical significance is required.

[Van Neck-Odelberg disease. Report of two cases]. / A van Neck-Odelberg-betegség bemutatása két eset kapcsán.

Osteochondritis ischiopubica or van Neck-Odelberg disease is characterized by atypical ossification of the ischiopubic synchondrosis. Clinical symptoms are usually pain, limping and limited range of motion of the hip joint. Radiologic images may be confused with the possibility of fracture, tumor or inflammation. In some cases it may be difficult to set up the accurate diagnosis, and during the diagnostic process it is essential that van Neck-Odelberg disease should be considered. In this paper the authors draw attention to this rare disorder and they present the history of two patients who posed diagnostic difficulties.

[OSGOOD-SCHLATTER DISEASE].

Osgood-Schlatter disease is a specific disorder related to osteochondropathies that affects young subjects and is localized in the tuberositas tibiae. The disease frequently develops after injuries including loading ones. It is apparent as gradual swelling of the knee joint(s) that becomes painful. Pain increases during walking, lower limb flexion an extension or stair climbing but may die down at rest. Diagnostics is based on the clinical picture. Radiodiagnostic methods my be helpful but their efficacy is inferior to that of clinical examination. Anti-inflammatory and chondroprotective therapy, immobilization of the affected joint, controlled exercises, and balneotherapy are indicated.

Treatment of Adolescent Blount Disease Using Taylor Spatial Frame With and Without Fibular Osteotomy: Is There any Difference?

BACKGROUND: In adolescents, Tibia Vara (Blount disease) patients usually present with combination of marked genu varum, procurvatum, and internal tibial torsion. When no growth remaining, standard treatment protocol for correction is osteotomy of the proximal tibia and fibula. In our study we compared 2 groups of patients: group A was treated with fibular osteotomy and group B was treated without fibular osteotomy. METHODS: Twenty-three patients (25 tibias), 21 males and 2 females, mean age of 14.7 years (range, 13 to 21 y) were included in our study. All patients underwent correction with Taylor spatial frame. Group A (with fibular osteotomy) included 11 tibias and group B (no fibular osteotomy) included 14 tibias. Group A underwent correction by proximal tibial and fibular osteotomies (fibula was fixed distally by 2 ilizarov wires to the distal ring). Group B was treated by proximal tibial osteotomy only (fibula was not osteotomized and was not fixed to the tibia). RESULTS: Correction goal was achieved in 9 cases in group A and 12 in group B. Mean time in frame was 15.9 weeks in group A and 14.14 in group B. Mean lengthening was 16.5 mm in group A and 12.8 mm in group B. Mean proximal tibia-fibula distance was 21.1 mm (group A) and 14.9 mm (group B). Mean distal tibia-fibula distance was 9.8 mm (group A) and 9.6 mm (group B). There was no ankle malalignment in both the groups. Complications included pin-tract infection in 11 patients and delayed union in 2 patients (1 in each group). CONCLUSION: We believe that in patients with minimal lengthening as needed in patients with adolescent Tibia Vara correction might be performed safely without osteotomy and fixation of the fibula. LEVEL OF EVIDENCE: Level III.