Hemiepiphysiodesis with tension band plate in idiopathic genu valgum: Insights on indications, outcomes, and follow-up from a systematic review and meta-analysis of more than 600 cases

Abstract

Aims: Hemiepiphysiodesis with tension band plates is widely used for the correction of idiopathic genu valgum in skeletally immature patients. Although widely adopted, considerable heterogeneity persists regarding indications, timing of intervention, and radiographic outcome assessment, limiting the development of standardized clinical pathways. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Studies reporting radiographic and clinical outcomes of hemiepiphysiodesis with tension band plates in idiopathic genu valgum were included. The study evaluates mechanical axis deviation (MAD), mechanical lateral distal femoral angle (mLDFA), and medial proximal tibial angle (MPTA), indication for surgery, timing of implant removal, complications, and follow-up interval. The risk of bias and quality of evidence were assessed using Cochrane guidelines. Results: A total of 11 studies, including more than 600 treated knees, were analyzed. Hemiepiphysiodesis resulted in significant improvement in coronal plane alignment. MAD improved by a pooled mean difference of 12.4 mm (p = 0.002). mLDFA shoed a mean correction of 5.2° (p = 0.004), while MPTA improved by 3.6° (p = 0.01). The overall complication rate was low (6.8%), mainly related to transient implant-site irritation and mild rebound growth, with no permanent physeal damage reported. Conclusions: Hemiepiphysiodesis with tension band plates provides safe, predictable, and clinically meaningful correction of idiopathic genu valgum in skeletally immature patients, supporting its role as a first-line surgical option and highlighting the importance of standardized radiographic monitoring and follow-up strategies to optimize timing of implant removal and minimize the risk of over- or under-correction.