Table 1.
Literature review of studies on DFEO and PTA
| Study | Sample size (n) | Mean age (years) | Mean follow up (months) | Level of evidence | Important conclusions |
|---|---|---|---|---|---|
| Stout et al. 2008 [52] | 73 | 13.8 | 15 | III | PTA combined with DFEO has better results when compared to both procedures in isolation |
| Filho et al. 2008 [54] | 12 | 13.1 | 28 | IV | DFEO + medial hamstring lengthening without PTA is effective in improving knee extension but recurrence and anterior pelvic tilt is common |
| Novacheck et al. 2009 [55] | 73 | NA | NA | III | Inclusion of PTA with DFEO is necessary to achieve optimal results |
| Joseph et al. 2010 [56] | 17 | 12.4 | 24 | IV |
Two staged surgery is recommended 6 weeks apart Stage 1—DFEO + PTA) Stage 2—Hamstring lengthening |
| Ganjwala 2011 [46] | 18 | 14.6 | 24 | IV | Multilevel surgery including DFEO + PTA improves mobility and function and the results are maintained till 2 years after surgery |
| Healy et al. 2011 [57] | 32 | NA | NA | IV | Concomitant hamstring lengthening is rarely needed with DFEO + PTA |
| Das et al. 2012 [58] | 14 | 13.6 | 36 | IV | DFEO + PTA improve function and knee extension and reduce knee pain |
| Inan et al. 2015 [59] | 28 | 13 | NA | IV | Reported 10% incidence of neurological complications. However it was not correlated with amount of deformity and correction |
| Lenhart et al. 2017 [53] | Experimental study | DFEO alone stretches the hamstrings and shortens the femur and quadriceps. A cuneiform wedge resection reduces the stretch on hamstring while PTA takes care of quadriceps shortening | |||
| Klotz et al. 2017 [60] | 22 | 12.1 | 15.6 | IV | PTA increases the anterior pelvic tilt |
| Boyer et al. 2017 [61] | 51 | 20 | 96 | III | DFEO + PTA causes knee extensor dysfunction during sit to stand activity |
| Boyer et al. 2018 [62] | 51 | 26.1 | 156 | III | DFEO + PTA improves knee extension in short term but does not impart any significant benefit in long term |
| Filho et al. 2018 [63] | 95 | 14.3 | 32.1 | III | Addition of PTA and hamstring lengthening increases the anterior pelvic tilt |
| Salami et al. 2018 [64] | 19 | 13 | 13–60 | III | DFEO + PTA improve knee kinematics at mid-term but does not increase the length or velocity of hamstring muscle |
| Pelrine et al. 2020 [65] | 51 | 12.8 | 12 | III | Surgery does not decrease the prevalence of knee pain |
| Aroojis et al. 2019 [66] | 26 | 14.3 | 22 | IV | DFEO + PTA are effective in treatment of crouch gait. Pediatric condylar locking compression plate provides stable fixation and allows for early mobilization |
| Park et al. 2019 [67] | 33 | 12.2 | 26.9 | IV | DFEO + PTA improve knee kinematics but increases anterior pelvic tilt and incidence of stiff knee gait |
| Hefny et al. 2020 [68] | 20 | 12.5 | 24 | IV | DFEO + PTA improve knee kinematics. Simultaneous hamstring lengthening increases anterior pelvic tilt |
| Hyer et al. 2021 [69] | 28 | 13.2 | 12 | IV | DFEO + PTA improves clinical, radiological and gait analysis parameters around knee |
| Emara et al. 2021 [70] | 20 | 11.1 | 16.2 | IV | DFEO + PTA improve the range and strength of knee extension and reduces knee pain |
| Liou et al. 2022 [71] | 25 | 11 | 12 | III | DFEO at a lower level with a distally placed plate near physis can produce genu valgum deformity. Fixation of osteotomy in slight varus is recommended |
| Erdal et al. 2022 [72] | 12 | NA | 37 | IV | The use of intraoperative neuromonitoring decreases the incidence of neurological complications |