Update on guided growth concepts around the knee in children.

Guided growth is part of the surgical armamentarium for limb-length discrepancy or axial deformity. It is an old concept, with several apparently conflicting techniques that are in fact usually complementary. Depending on whether the aim is to slow or arrest growth, to treat length discrepancy or axial deviation, techniques differ and the choice is partly determined by the indication. It is thus essential to know the technical details for each: temporary or definitive, complete or asymmetric, with or without implant. Considerations of fashion and personal habits may outweigh basic principles, and it is important to go back to the princeps descriptions: the Phemister, Bowen, Blount, Métaizeau and Stevens techniques and others all have their surgical specificities Apart from surgery itself, he indication and choice of technique depend on the patient's age and whether the abnormality to be treated is isolated or part of a wider syndrome, all of this being included in a precise strategy based on planning calculations that are indispensable ahead of any surgery. Guided growth can also be implemented elsewhere than in the limbs: wrist, ankle, or even hip; and it is beginning to be possible to correct sagittal and rotational deformities. All of this is furthermore achievable using emerging techniques that are less invasive, are reversible, and show equal efficacy.

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