Double osteotomy for the treatment of severe Blount disease.

BACKGROUND: Treatment for severe/relapsing Blount disease is controversial. The purpose of this study is to assess the safety and efficacy of acute medial plateau elevation with concurrent tibial gradual osteotomy.

METHODS: This study is a retrospective review of 16 patients (22 limbs) treated by combined plateau elevation and tibial osteotomy for the treatment of Blount disease. We measured the tibiofemoral angle, medial proximal tibial angle, and the plateau angle.

RESULTS: All measurements improved significantly preoperatively to postoperatively. The tibiofemoral angle from 29 degrees varus to 3 degrees of valgus, anatomic medial proximal tibial angle from 55 degrees to 86 degrees, and the plateau angle from 37 degrees to 12 degrees (P<0.05). Five patients were considered to have failed which appeared to be the result of undercorrection and subsequent recurrence of the tibial osteotomy and not the plateau elevation.

CONCLUSIONS: The double osteotomy for Blount disease achieved significant improvement in all patients recurrence appeared to be because of under correction and subsequent worsening of the tibial osteotomy and not collapse of the plateau elevation.

LEVEL OF EVIDENCE: IV.