Peer-reviewed article
Most Coronal Knee Deformities of Healed Nutritional Rickets Under 8 Years of Age Remodel Spontaneously: Building Evidence for Practice Change.
Mostafa M Baraka, Shady Samir, Shady Mahmoud, Tamer A El-Sobky ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study followed 57 children (109 knees) with knee deformities from healed nutritional rickets over one year to understand how these deformities naturally correct themselves. Children under 8 years old had much better spontaneous correction than older children, with 70% achieving complete remodeling compared to only 12.5% of those over 8 years. The severity of the deformity mattered: moderate deformities (under 16 degrees for outward-bending, 13 degrees for inward-bending knees) were more likely to correct naturally. The findings suggest many children are receiving unnecessary surgery when they would recover naturally with time.
Key points
- Mean age of children with complete knee remodeling was 4.9 years versus 8.4 years for those with complete failure of remodeling (P=0.000)
- Children over 8 years of age had 87.5% failure of remodeling compared to 29.9% in children aged 8 years or younger (P=0.000, OR=16.4)
- Deformity severity predicted remodeling: valgum deformities greater than 16.5 degrees and varum greater than 13 degrees were less likely to remodel spontaneously
- Child sex, deformity direction (inward vs outward bending), and whether deformity was one-sided or both-sided did not significantly affect remodeling outcomes
- Study authors recommend children under 8 years with moderate deformities should be observed for at least 1 year before considering surgery, as most will spontaneously correct
Limitations
The study has a relatively small sample size (57 patients) and only followed children for one year, so longer-term outcomes are unknown. The study does not specify the geographic location or population characteristics, limiting understanding of how findings apply to different contexts.
Abstract
BACKGROUND: Nutritional rickets remains a global health burden. The optimal management of coronal knee deformities in children/adolescents with healed nutritional rickets as to the indications of conservative treatment versus guided growth surgery remains unsettled. The objective was to report the natural history of disease regarding the remodeling potential of coronal knee deformities and isolate potential patient- and deformity-related factors that are predictors of favorable deformity remodeling. METHODS: We prospectively assessed 109 knees in 57 patients-mean age, 6.1 years (range, 2 to 12)-for spontaneous correction of their coronal knee deformities over a period of 1 year. Male/female:33/24, valgum/varum:34/23, bilateral/unilateral:52/5 patients. Outcome variables were, radiologic tibiofemoral angle and a questionnaire to assess parent satisfaction. They were correlated to independent patient- and deformity-related variables, including age, sex, deformity direction/severity, and laterality. RESULTS: The mean age of patients that achieved complete knee remodeling (4.9 y) was significantly lower compared with patients who experienced complete failure of remodeling (8.4 y), P =0.000, (95% CI, 4.3-5.4). In 109 knees, there was a highly significant negative Spearman correlation coefficient between age and degrees of coronal correction, patient satisfaction, and complete failure of remodeling R=-0.660, R=-0.475, R=-0.434, respectively, P <0.001. The knees of patients >8 years of age that failed to remodel (87.5%) was significantly higher compared with patients ≤8 years (29.9%), P =0.000, OR=16.4, (95% CI, 5.2-52.2). There were statistically significant correlations between deformity severity/tibiofemoral angle and the remodeling potential, with a cutoff angle of 16.5 degrees/13 degrees for valgum/varum above which deformities were less likely to remodel spontaneously, P =0.03, P =0.007. Complete knee remodeling in unilateral deformities was statistically but not clinically significant. Correlations of sex and deformity direction with remodeling outcomes were insignificant. The inter- and intrarater agreements were excellent for the radiologic tibiofemoral angle measurements (ICC=0.993, CI, 0.982-0.997, P <0.01) and (ICC=0.994, CI, 0.987-0.998, P <0.01), respectively. CONCLUSION: Children with coronal knee deformities of healed nutritional rickets under the age of 8 years should be given the full opportunity to remodel spontaneously for at least 1 year, particularly children with moderate deformities ≤16 degrees. This is irrespective of sex, deformity direction, and laterality. Most deformities remodel spontaneously. This suggests that these deformities may be overtreated. This could reduce unnecessary surgeries and potentiate cost-effectiveness of treatment and risk-benefit profile. LEVEL OF EVIDENCE: Level IV prognostic studies-investigating the effect of a patient characteristic on the outcome of disease.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Observation and conservative management (no intervention) to allow natural remodeling of coronal knee deformities over 1 year
- Population
- 57 children (109 knees) with mean age 6.1 years (range 2-12 years) presenting with coronal knee deformities from healed nutritional rickets
Key finding
70.1% of children aged 8 years or younger achieved complete spontaneous knee remodeling versus 12.5% of children over 8 years