Operative Elevation of the Medial Tibial Joint Surface in Blount's Disease: One Case Observed for 18 Years After Operation

From follow-up studies of 71 cases with Blount's disease, Langenskidd ( 1964) concluded that tibio-fibular osteotomy provides a favourable outlook when performed before the age of eight years.Later, osteotomies are of less benefit and often have to be repeated.In addition, at the age of twelve the operation must be supplemented with epiphysiodesis of the lateral tibial condyle and fibular head.However, in some cases with extreme sloping, osteotomy will not suffice.The lack of support for the medial femoral condyle and the ensuing laxity of the lateral ligaments result in a varus position, which will be aggravated on weight-bearing (Figure 2).The logical treatment would be to elevate the sloping medial tibial joint surface to its normal level.The first report of an operation of this sort appears to be given by Langenskidd (1964), who reported good results after five-years' follow-up in his three cases.The scarcity of reports on this useful operation is believed to warrant a report on one case, which I operated by the elevation technique in 1951, and have followed-up for 18 years. C A S E R E P O R TM.G., female, born 1G July 1938.The patient was first examined a t five years of age because of pains in the right knee, which showed a slight varus.X-ray revealed beginning Blount's disease.She failed to Deturn for control until she was eight, when she had developed a marked genu varum.23 July 1946: she had a tibio-fibular osteotomy with overcorrection in valgus.However, the varus deformity gradually recurred, and four years after the first operation, on 16 April 1950, a second tibio-fibular osteotomy was performed with overcorrection to ten degrees valgus.