LAUSR

We read with interest the recent publication by Aik Saw et al. The authors used Ilizarov frame and Taylor spatial frame (TSF) to perform simultaneous correction of all the metaphyseal deformities without elevating the medial tibial plateau for Blount disease. There are some concerns about this work. First, the depression of medial plateau of the tibia may be a risk for development of early osteoarthritis. For the young kid, there is unossified epiphyseal cartilage in the medial tibial plateau. It may be more appropriate to pursue an extra-articular approach rather than an intraarticular osteotomy to restore the alignment of the lower extremity. But for the young adult, it is better to correct both intra-articular and extra-articular deformity to avoid early onset osteoarthritis. Second, the authors cited Sanjeev Sabharwal et al.’s publication in the Journal of Bone and Joint Surgery, American volume 2012 as evidence that it is not necessary to elevate the medial tibial plateau. Sanjeev Sabharwal et al. found secondary changes in the medial column including thickening of the medial meniscus and articular cartilage may contribute toward the integrity of the medial column. Also, review of the clinical data of this article shows the mean age of the patients was 10.5 years, which was much younger than the authors’ patients (mean age 15 years). There were also some young adults in the authors’ patients group. The thickness of the articular cartilage of the adult is not as same as the young kid. Finally, there was no comparison of the outcome into those who had Ilizarov or TSF devices. As we know, TSF is much expensive than Ilizarov frame. It is difficult for patients to pay for TSF in developing countries. So, the cost-effectiveness of the treatment should be assessed.