Case Study: Guided growth heads off Blount’s disease bowing in 12-year-old

Learn about the diagnosis and innovative treatment of Blount's disease in a 12-year-old male. This case study details how guided growth surgery was used to correct significant tibial bowing, offering a less-invasive alternative to traditional osteotomy and improving long-term patient outcomes.

Author: Norton Children’s

Published: September 23, 2025

The patient

A 12-year-old male initially was seen for significant bowing of the right tibia, causing knee pain — and his mom noted increasing deformity as he was growing older. There was concern for continued bowing of the leg, causing long-term issues with the right knee. He was having mild to moderate knee pain, which was starting to limit play and athletic activities.

Initial X-rays at presentation demonstrate significant varus of the right knee compared with relatively neutral alignment of the left.

The alignment line from hip to ankle falls significantly inside the right knee joint, demonstrating significant deformity.

The challenge

Examination demonstrated significant varus of the right leg at the knee, with altered gait, and mild laxity of the right knee. Standing X-rays demonstrated abnormal alignment of the right leg, with varus of the right knee caused by abnormal growth of the upper portion of the tibia, causing the bone to grow at an angle. X-ray findings were consistent with adolescent Blount’s disease, which is a disorder of the growth plate of the medial proximal tibia of unknown cause. This leads to altered growth of this portion of the bone, causing bowing deformity of the tibia that progresses.

With continued growth and angulation, this would cause significant, increasing knee pain and arthritis as a young adult. This would normally necessitate significant surgery to cut the bone and realign the bone — with a prolonged healing process and recovery.

The solution

Based on the child’s age and the fact that he still had growth remaining, we elected to perform guided growth surgery. This is a much less invasive option where a small, two-hole plate is applied over the growth plate to tether the growth plate on the outside of the knee. This allows gradual improvement in the alignment with growth more on the medial side of the knee, with a much quicker recovery. It allows continued growth of the leg without the need for a major invasive osteotomy surgery.

Standing X-ray of the legs eight months after surgery shows significant improvement of the alignment of the right leg with growth.

The result

After applying the two-hole guided growth plate to the right leg, follow-up X-rays demonstrated improved alignment over approximately one year, and the child subsequently underwent hardware removal once the alignment had corrected. He was cleared to resume all normal activities following hardware removal. Plates were subsequently removed a few weeks later.