INTRODUCTION:

Bone modelling is the process by which bones change shape or size in response to physiologic influences or mechanical forces [1]. Dysregulation of bone modelling in lower extremities due to genetic, environmental or bio- mechanical factors leads to angular varus-valgus defor- mities and leg length discrepancies [2-4]. These relative- ly common conditions may lead to gait disturbance, in- stability and pain, and predispose to early degenerative articular changes later in adulthood if corrective surgery is not performed [5- 6]. Since longitudinal growth occurs mostly around theknee, specifically around the distal femoral and proximal tibial physes, initial efforts to modulate lower limb growth concentrated on this anatomical area [1]. Minimally inva- sive techniques aiming to reach permanent or reversible hemiepiphysiodesis were developed including rigid sta- pling, percutaneous transphyseal screwing and tension band plating among others [6-9]. These techniques fol- low the Hueter-Wolkman principle [10]. Also, limb lengthening procedures has developed considerably since the beginning of the 20thcentury [11-13]. Most ofthem rely on long bone distraction following osteotomy through the shaft or the metaphysis [14-15]. Metaphy- seal osteotomies are associated with higher rates of con- solidation and faster bone healing [16-18], due to a greater osteogenesis potential near the physis [16-18]. On the other hand, it has been shown that periosteal violation leads to appositional bone growth disturbance [19].We postulated that percutaneous juxtaphyseal meta-physeal perforations could increase bone growth given the rich vascularisation of the metaphysis and its prox- imity to the physis, leading to bone shape and length mod- ification. This study was conducted to validate this hypo- thesis and to set grounds for future applications of this technique.

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