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Meta-Analysis
. 2025 Apr 11;26(1):355.
doi: 10.1186/s12891-025-08540-z.

Percutaneous epiphysiodesis transphyseal screw versus tension-band plating as hemiepiphysiodesis in treating coronal angular knee deformities: a systematic review and meta-analysis of comparative studies

Ahmed O Sabry  1 , Mohamed K A Genedy  2   3 , Salma Abouelwafa  2   3 , Ahmed A Khalil  2   3 , Omar Mady  2   3 , Noureldin Mostafa  2   3 , Rana Ali Ahmed Elsayed  2   3 , Hassan Elbarbary  2 , Mohamed Hegazy  2 , Amr Abdelgawad  4
Affiliations
Meta-Analysis

Percutaneous epiphysiodesis transphyseal screw versus tension-band plating as hemiepiphysiodesis in treating coronal angular knee deformities: a systematic review and meta-analysis of comparative studies

Ahmed O Sabry et al. BMC Musculoskelet Disord. .

Abstract

Background: Angular knee deformities such as genu varum and genu valgum are common in children and can impact their functional mobility and quality of life. Although surgical interventions like guided growth plates or tension-band plates (TBP) and percutaneous epiphysiodesis transphyseal screws (PETS) are commonly used, comparative analyses of their efficacy and safety are limited. This study aims to evaluate the correction rates and safety profiles of TBP and PETS in treating pediatric coronal angular knee deformities.

Methods: A comprehensive literature search was conducted in Scopus, Web of Science, and PubMed until November 2024. Only comparative clinical studies comparing PETS and TBP in pediatric patients with coronal knee deformities were included.

Results: A total of five studies encompassing 473 physes were included. Their methodological quality was assessed using the MINORS criteria, with scores ranging from 18 to 19, indicating a low risk of bias. PETS demonstrated significantly higher correction rates compared to TBP, with an overall pooled mean difference in angular correction of 0.17°/month (p < 0.0003). In the femoral subgroup analysis (LDFA), the mean difference correction rate was 0.21°/month in favor of PETS (p = 0.01). Additionally, the PETS group achieved a statistically significant mechanical axis deviation mean difference correction rate of 1.02 mm/month (p = 0.006). Complication rates were relatively lower with PETS across all included studies.

Conclusion: PETS achieves faster angular and mechanical axis deviation correction rates compared to TBP, highlighting its efficiency in treating pediatric coronal angular knee deformities. Additionally, PETS demonstrates relatively fewer complications, reinforcing its position as a more effective and cost-efficient option for guided growth in children.

Clinical trial number: Not applicable.

Level of evidence: II.

Keywords: Angular knee deformities; Genu valgum; Genu varum; Hemiepiphysiodesis; Meta-Analysis; Percutaneous epiphysiodesis transphyseal screw; Systematic review; Tension-band plating.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. This study is a systematic review and meta-analysis of previously published studies and does not involve human participants or require ethical approval. Consent for publication: Not applicable. This study does not include any individual participant data requiring consent for publication. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow chart
Fig. 2
Fig. 2
Angular correction rate forest plot. (A) MPTA correction rate subgroup. (B) LDFA correction rate subgroup. (C) non-specific correction rate subgroup
Fig. 3
Fig. 3
Angular correction rate sensitivity analysis plot
Fig. 4
Fig. 4
MAD correction rate forest plot
Fig. 5
Fig. 5
Mechanisms of PETS and TBP: (A) PETS is inserted obliquely, with threads crossing the physis to limit growth, halting it immediately. (B) As the concave side lengthens, the screw head anchors and may pull threads out of the physis upon correction. (C) TBP is fixed with screws placed parallel to the physis. (D) Growth tension pushes the flexible screws outward, causing divergence and halting growth
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