TY - JOUR
T1 - An International Consensus on Evaluation and Management of Idiopathic Genu Valgum
T2 - A Modified Delphi Survey
AU - Ranade, Ashish S.
AU - Oka, Gauri A.
AU - Belthur, Mohan V.
AU - Shah, Hitesh
AU - Herman, Martin J.
AU - Fernandes, James A.
AU - Hamdy, Reggie
AU - Hailer, Yasmin D.
AU - Canavese, Federico
AU - Monsell, Fergal
AU - Gelfer, Yael
AU - Eastwood, Deborah M.
AU - Huser, Aaron
AU - Laine, Jennifer
AU - McCarthy, James
AU - Aroojis, Alaric
AU - Cooper, Anthony
AU - Barr, Alejandro
AU - Herman Mare, Pieter
AU - Hosny, Gamal A.
AU - Kishan, Shyam
AU - Marangoz, Salih
AU - Moreno Grangeiro, Patricia
AU - Møller-Madsen, Bjarne
AU - Nunn, Timothy
AU - Shah, Maulin
N1 - Publisher Copyright:
Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2025/5/1
Y1 - 2025/5/1
N2 - Background: Idiopathic genu valgum beyond physiological limits may require treatment, which is based on age, growth remaining, and the magnitude of the deformity. There is no consensus on clinical, or radiologic evaluation, indications, and management of idiopathic genu valgum, which can range from observation to surgical treatment using various modalities. If available, such guidelines will help surgeons offer optimal treatment to their patients. The aim of our study was to establish an expert consensus on the evaluation and treatment of idiopathic genu valgum. Methods: An international panel of 29 pediatric orthopaedic surgeons from 17 countries with clinical and research experience in the management of limb deformity participated in a modified Delphi survey. Surgeons were provided with patient and deformity characteristics and voted on 46 statements on history, clinical examination, radiographic evaluation, and treatment options for idiopathic genu valgum in round 1. Consensus was defined as when statements received ≥70% votes. Statements that were important but received <70% votes were reworded for clarity in round 2 (n=13). Results: Consensus was achieved for 28/46 statements and included obtaining a full-length standing radiograph of the lower extremities and measuring joint orientation angles. Participants did not agree to offer surgical treatment based only on the intermalleolar distance. They recommended surgical treatment if the mechanical axis falls in zone 2 or beyond on the lateral side and using guided growth by tension-band plating when the growth remaining is at least 2 years. The panel agreed on performing common peroneal nerve decompression for specific indications such as acute, opening wedge osteotomy of >20 degrees, but not for gradual correction. Consensus was not reached for indications and methods of bone age assessment, treatment when growth remaining is <1 year, indications for implant removal after guided growth in younger children, and the type of osteotomy for acute deformity correction. Conclusions: We have generated consensus statements to guide the management of idiopathic genu valgum. Statements that lack consensus are areas for future multicenter research.
AB - Background: Idiopathic genu valgum beyond physiological limits may require treatment, which is based on age, growth remaining, and the magnitude of the deformity. There is no consensus on clinical, or radiologic evaluation, indications, and management of idiopathic genu valgum, which can range from observation to surgical treatment using various modalities. If available, such guidelines will help surgeons offer optimal treatment to their patients. The aim of our study was to establish an expert consensus on the evaluation and treatment of idiopathic genu valgum. Methods: An international panel of 29 pediatric orthopaedic surgeons from 17 countries with clinical and research experience in the management of limb deformity participated in a modified Delphi survey. Surgeons were provided with patient and deformity characteristics and voted on 46 statements on history, clinical examination, radiographic evaluation, and treatment options for idiopathic genu valgum in round 1. Consensus was defined as when statements received ≥70% votes. Statements that were important but received <70% votes were reworded for clarity in round 2 (n=13). Results: Consensus was achieved for 28/46 statements and included obtaining a full-length standing radiograph of the lower extremities and measuring joint orientation angles. Participants did not agree to offer surgical treatment based only on the intermalleolar distance. They recommended surgical treatment if the mechanical axis falls in zone 2 or beyond on the lateral side and using guided growth by tension-band plating when the growth remaining is at least 2 years. The panel agreed on performing common peroneal nerve decompression for specific indications such as acute, opening wedge osteotomy of >20 degrees, but not for gradual correction. Consensus was not reached for indications and methods of bone age assessment, treatment when growth remaining is <1 year, indications for implant removal after guided growth in younger children, and the type of osteotomy for acute deformity correction. Conclusions: We have generated consensus statements to guide the management of idiopathic genu valgum. Statements that lack consensus are areas for future multicenter research.
KW - deformity correction
KW - genu valgum
KW - growth modulation
KW - guided growth
KW - idiopathic genu valgum
KW - osteotomy
KW - treatment
UR - https://www.scopus.com/pages/publications/85217750771
U2 - 10.1097/BPO.0000000000002908
DO - 10.1097/BPO.0000000000002908
M3 - Article
C2 - 39901614
AN - SCOPUS:85217750771
SN - 0271-6798
VL - 45
SP - 274
EP - 280
JO - Journal of Pediatric Orthopaedics
JF - Journal of Pediatric Orthopaedics
IS - 5
ER -