Overcorrection Provides Better Final Coronal Plane Alignment in Genu Varum Patients Treated With Tension-Band Plating and Followed Up to Skeletal Maturity

BACKGROUND: Genu varum deformity in skeletally immature patients can lead to long-term functional impairment and degenerative joint changes if untreated. Temporary hemiepiphysiodesis using tension-band plating is a widely accepted method for gradual correction; however, the rebound phenomenon remains a significant concern, especially in patients with underlying diseases. Intentional overcorrection has been proposed to mitigate this risk, but its effectiveness in genu varum is not well established. The purpose of this study is to evaluate the effect of overcorrection at the time of implant removal on final coronal alignment in pediatric patients with genu varum treated with guided growth. METHODS: This retrospective study included 27 bone segments treated with temporary hemiepiphysiodesis between 2014 and 2024. Radiographic parameters, including mechanical lateral distal femoral angle (mLDFA) and mechanical medial proximal tibial angle (mMPTA), were independently measured by 2 observers preoperatively, at implant removal, and at final follow-up. The mean of the 2 observers' measurements was used for all subsequent analyses. Segments were classified as overcorrected or not overcorrected at implant removal, and undercorrected, normal, or overcorrected at last follow-up. RESULTS: Median follow-up after implant removal was 88 months. Based on the mean measurements of the 2 observers, distal femoral alignment remained stable between implant removal and final follow-up (adjusted P=1.000), whereas proximal tibial segments demonstrated a significant change toward recurrent varus (adjusted P=0.013). Normal alignment at final follow-up was observed in 66.7% of segments that were overcorrected at implant removal compared with 26.7% of those that were not overcorrected (OR=5.50, 95% CI 1.05-28.88; P=0.038). Inter-rater reliability was excellent for both mLDFA and mMPTA measurements. No implant-related complications were observed. CONCLUSION: Overcorrection at the time of implant removal was associated with a higher likelihood of normal coronal alignment at final follow-up in this cohort. Distal femoral correction remained relatively stable after implant removal, whereas proximal tibial segments demonstrated a greater tendency toward recurrent varus. These findings support further investigation of intentional overcorrection as a strategy for managing rebound after guided growth. LEVEL OF EVIDENCE: Level 4.