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. 2020 May 29;12(5):e8353.
doi: 10.7759/cureus.8353.

Prognostic Reliability of a New Classification System for Blount's Disease

Achraf H Jardaly  1 , Michael Conklin  1 , Shane F Strom  1 , Kevin C Wall  1 , Shawn Gilbert  1
Affiliations

Prognostic Reliability of a New Classification System for Blount's Disease

Achraf H Jardaly et al. Cureus. .

Abstract

Objective We conducted this study to evaluate the reproducibility of a new classification system for Blount's disease and assess its correlation with established radiological measures used to evaluate the severity of this disorder. Materials and Methods This is a retrospective review of children with Blount's disease that were younger than 10 years of age. Recurrence was defined as the need for a second corrective surgery. Radiographs immediately pre-surgery and at final follow-up were used to measure mechanical axis (MA), tibial metaphyseal-diaphyseal angle (TMDA), epiphyseal-metaphyseal angle (EMA), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA). Patients were stratified according to the new classification (Type A, B, or C). Results Sixty-five limbs from 16 males and 24 females met our inclusion criteria. The average follow-up was 4.2 years. Twelve patients (with 22 Type-A extremities) underwent bracing with a success rate of 54%. Thirty-four patients (53 extremities) underwent surgical correction. The recurrence rate was 35.8%. Group C had a recurrence rate of 62%, higher than that of Group B (33%), and Group A (23%) (P = 0.026). In addition, irrespective of reoperation, patients in Group C had the least change in the MA (62%, P = 0.046) and the most severe values of MPTA and TMDA initially and after the operation (P < 0.05). Conclusion The new classification system for Blount's disease holds validity for predicting recurrence. The severity of the grades is correlated with the TMDA, MPTA, and varus reversibility. This can aid physicians and families in making an informed decision and setting treatment goals.

Keywords: blount's disease; classification system; lamont classification; langenskiold classification; prognosis; recurrence; tibia vara.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. X-rays demonstrating an example of Types A, B, and C according to the LaMont et al. classification for Blount’s disease
LaMont et al. [8]
Figure 2
Figure 2. The change of the mechanical axis (MA) based on the new classification
Figure 3
Figure 3. Initial and final medial proximal tibial angle (MPTA)
The shaded area represents the normal range of the MPTA (85˚-90˚) Pre: immediate pre-surgery; Post: final follow-up
Figure 4
Figure 4. Initial and final tibial metaphyseal diaphyseal angle (TMDA)
The shaded area represents the normal value for the TMDA (≤ 11˚). Pre: Immediate pre-surgery; Post: final follow-up
See this image and copyright information in PMC

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