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Hemi-epiphysiodesis (guided growth) for leg length discrepancies (LLD)

Hemi-epiphysiodesis (guided growth) for leg length discrepancies (LLD) is a minimally invasive and highly effective surgical procedure for treating lower limb length discrepancy in children. It involves the application of fixation devices (mostly plates) on both sides of the knee’s growth plate to slow overall growth in this area and thus slow overall growth of the limb. In the months/years following surgery, growth continues in the contralateral limb, progressively improving the length discrepancy.
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Hemi-epiphysiodesis (guided growth) for leg length discrepancies (LLD) is a minimally invasive and highly effective surgical procedure for the treatment of lower limb length discrepancy in children.

Hemi-epiphysiodesis (guided growth): what does it mean?

Hemi-epiphysiodesisis a surgical procedure aimed at stopping or slowing the growth of a specific growth plate or part of it.

Growth plates (also called physes) are the typical structures in children’s bones that allow the various bone segments to grow in length. They can be imagined as cartilage discs located at either end of a long bone, in which cartilage cells reproduce longitudinally and progressively ossify, thus increasing the length of the segment.
These cartilages are active throughout the child’s growth and cease their activity with skeletal maturity, when the cartilage closes and is completely replaced by bone.

Normal radiographic appearance of the knee growth plates (a) and diagram showing the physiological growth patterns (b)
Normal radiographic appearance of the knee growth plates (a) and diagram showing the physiological growth patterns (b)

Hemi-epiphysiodesis (guided growth) for leg length discrepancies (LLD): what does it consist of?

It consists of slowing the growth (epiphysiodesis) on both sides of the growth plate of the knee in order to slow the overall growth of this area and therefore slow the overall growth of the limb.

In the months/years following surgery, growth continues in the contralateral limb, progressively leading to equalization of the length difference.

Hemi-epiphysiodesis (guided growth) for leg length discrepancies (LLD): how is it performed?

Hemi-epiphysiodesis can be:

  • Temporary and reversible: synthetic materials are applied that slow growth as long as they are in place. Once removed, growth can theoretically restart.
  • definitive : a definitive arrest of growth occurs in that area

Hemi-epiphysiodesis (guided growth) for leg length discrepancies (LLD) : what implants?

Epiphysiodesis can be performed with:

  • 8 plates: it is the most used implant
  • camber
  • cannulated screws
Examples of epiphysiodesis performed in our center with 8 femoral plates (a), with percutaneous screws (b), with 8 tibial plates (c)
Examples of epiphysiodesis performed in our center with 8 femoral plates (a), with percutaneous screws (b), with 8 tibial plates (c)

Hemi-epiphysiodesis (guided growth) for leg length discrepancies (LLD): when should it be performed?

This surgical procedure is generally reserved for minor length differences, approximately 2-3.5 cm. It is a minimally invasive procedure , with rapid functional recovery.

It requires experience and careful planning to choose the best time to perform the procedure.

Hemi-epiphysiodesis (guided growth) for leg length discrepancies (LLD): risks

There are two types of risk:

  • If performed too early it risks causing excessive shortening of the operated limb
  • If performed late, it risks being ineffective

OrthoChildren Center regularly carries out this type of intervention