Abstract
Thank you for highlighting these two issues related to the published article. Although some surgeons would adopt more liberal indications for intra-articular reconstruction, we should remember that the architecture of these joints is the end result of healing and remodelling process over the paediatric period. The fact that these patients (some with bilateral deformities) were able to continue walking for years before seeking treatment at adolescent/adult age reflects that the knee is inherently different from adult knee with combination of intra-articular and extra-articular deformities. In addition, intra-articular surgery will generally require few additional procedures, among others are realignment osteotomy at the level below tibia tuberosity, two sets of fixation implants and bone grafting. We would like to show that satisfactory short-term outcome of Blount’s disease in adolescents and young adults could be achieved with a less complicated procedure in our cases. There had been very few long-term outcome studies on patients treated with either extra-articular correction or combination of extra-articular and intra-articular corrections.
Procurvatum and internal tibial torsion are two common associated deformities that cannot be easily corrected with conventional Ilizarov external fixators. Currently, there are many types of hexapod external fixator that can be used to simultaneously correct these deformities, and some of them are relatively inexpensive. However, further discussion on the cost and availability of these devices is beyond the scope of this paper.
