{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:56:05Z","timestamp":1790142965911,"version":"4.0.1"},"reference-count":24,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,6,26]],"date-time":"2019-06-26T00:00:00Z","timestamp":1561507200000},"content-version":"vor","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>This study was aimed to find the radiographic parameter predicting recurrence of stage 2 Blount's disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We retrospectively reviewed radiographs of 82 legs from 49 patients diagnosed with stage 2 Blount's disease by Langenski\u00f6ld classification who had failed brace treatment and underwent valgus osteotomy between 1998 to 2016. Age ranged from 26 to 47\u2009months. The metaphyseal\u2013diaphyseal angle was measured preoperatively. The medial metaphyseal slope of the proximal tibia and femorotibial angle were measured preoperatively and 3, 6, 12, and 24\u2009months postoperatively in both non\u2010recurrence (group 1) and recurrence (group 2) group. The receiver operating characteristic curve calculated using MedCalc software was used to determine the medial metaphyseal slope predicting risk for recurrence. Statistical analysis was performed using SPSS software.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean follow\u2010up time was 4.83 \u00b1 0.38\u2009years. The mean age was 34.57 \u00b1 5.76 in group 1 and 33.2 \u00b1 1.48 in group 2 (<jats:italic>P<\/jats:italic> = 0.258). The mean preoperative metaphyseal slope was 62.39\u00b0 \u00b1 9.75\u00b0 in group 1 and 73.22\u00b0 \u00b1 6.59\u00b0 in group 2 (<jats:italic>P<\/jats:italic> = 0.02). The mean preoperative femorotibial angle (FTA) was \u221214.31\u00b0 \u00b1 8.25\u00b0 in group 1 and \u221218.89\u00b0 \u00b1 7.74\u00b0 in group 2 (<jats:italic>P<\/jats:italic> = 0.1). The mean preoperative metaphyseal diaphyseal angle (MDA) was 14.75\u00b0 \u00b1 4.21\u00b0 in group 1 and 20.11\u00b0\u2009\u00b15.16\u00b0 in group 2 (<jats:italic>P<\/jats:italic> = 0.001). Demographic data including age, gender, weight, height, and body mass index showed no statistically significant difference between both groups. Out of 82 legs, 9 (10.97%) had recurrence. Preoperatively, the metaphyseal\u2013diaphyseal angle showed statistical significance between both groups. The medial metaphyseal slope showed statistically significant difference between group 1 and group 2 at 3, 6, 12, and 24\u2009months postoperatively. The receiver operating characteristic curve showed that a medial metaphyseal slope more than 70\u00b0 at 12\u2009months (sensitivity 88.89% and specificity 69.86%) and more than 62\u00b0 at 24\u2009months postoperatively (sensitivity 100%, specificity 52.3%) was a predictor for recurrence of stage 2 Blount's disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Medial metaphyseal slope more than 62\u00b0 over the 24\u2010month follow\u2010up was associated with recurrence of varus deformity.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.12491","type":"journal-article","created":{"date-parts":[[2019,6,27]],"date-time":"2019-06-27T04:36:36Z","timestamp":1561610196000},"page":"474-480","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Medial Metaphyseal Slope as a Predictor of Recurrence in Blount Disease"],"prefix":"10.1111","volume":"11","author":[{"given":"Tinh","family":"Laoharojanaphand","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thanase","family":"Ariyawatkul","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamolporn","family":"Kaewpornsawan","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chatupon","family":"Chotigavanichaya","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jidapa","family":"Wongcharoenwatana","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2634-1175","authenticated-orcid":false,"given":"Perajit","family":"Eamsobhana","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,6,26]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-199805000-00020"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-199801000-00019"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199301000-00017"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198264080-00006"},{"key":"e_1_2_6_6_1","first-page":"141","article-title":"Tibia vara, osteochondrosis deformans tibiae","volume":"3","author":"Blount WP","year":"1966","journal-title":"Curr Pract Orthop Surg"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-014-2365-3"},{"key":"e_1_2_6_8_1","first-page":"72","article-title":"Early proximal tibial valgus osteotomy as a very important prognostic factor in Thai children with infantile tibia vara","volume":"88","author":"Kaewpornsawan K","year":"2005","journal-title":"J Med Assoc Thai"},{"key":"e_1_2_6_9_1","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1097\/00003086-198107000-00011","article-title":"Tibia vara: steochondrosis deformans tibiae Blount's disease","volume":"158","author":"Langenski\u00f6ld A","year":"1981","journal-title":"Clin Orthop"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198264040-00026"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198264070-00006"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-198505020-00012"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-198701000-00001"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0b013e3181b768d9"},{"key":"e_1_2_6_15_1","first-page":"130","article-title":"Recurrence of varus deformity after proximal tibial osteotomy in Blount disease: long\u2010term follow\u2010up","volume":"25","author":"Gonz\u00e0lez\u2010Herranz P","year":"2005","journal-title":"J Pediatr Orthop"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.82B7.10507"},{"key":"e_1_2_6_17_1","first-page":"29","article-title":"Blount disease. 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