The Effectiveness of Different Minimally Invasive Epiphysiodesis Techniques in the Management of Paediatric Leg Length Discrepancies: A Systematic Review Dr Megan Cain Master of Clinical Science The Joanna Briggs Institute Faculty of Health Sciences The University of Adelaide, South Australia 18th November 2018 1 Table of Contents Table of Contents ............................................................................................................. 2 Acknowledgements ........................................................................................................... 5 Declarations ..................................................................................................................... 6 Abstract ............................................................................................................................. 7 Dissertation structure ....................................................................................................... 9 List of abbreviations ....................................................................................................... 10 List of definitions ........................................................................................................... 11 Chapter 1: Introduction ................................................................................................. 14 What is a leg length discrepancy? ............................................................................. 14 Causes of leg length discrepancies ............................................................................. 15 Leg length discrepancy classification ........................................................................ 16 Clinical assessment ..................................................................................................... 16 Radiological assessment of leg length discrepancies ................................................ 18 Consequences of leg length discrepancies ................................................................. 24 Impact on patients’ quality of life ............................................................................. 27 Predicting the magnitude of a leg length discrepancy ............................................. 27 Different techniques for predicting the magnitude of a leg length discrepancy .................... 29 Treatment of leg length discrepancies ...................................................................... 34 Non-operative ........................................................................................................................ 34 Shortening of the long limb ................................................................................................... 35 Lengthening of the short limb (distraction osteogenesis or callotasis) .................................. 36 History of epiphysiodesis ............................................................................................ 39 Types of epiphysiodesis .............................................................................................. 40 Phemister ............................................................................................................................... 40 Percutaneous drilling and curettage....................................................................................... 41 Percutaneous epiphysiodesis using transphyseal screws ....................................................... 42 Physeal staples ...................................................................................................................... 45 Eight-Plates ........................................................................................................................... 46 Experimental and other epiphysiodesis techniques ............................................................... 47 Anatomy of epiphysiodesis ......................................................................................... 47 Methodological basis for the review .......................................................................... 49 Evidence-based medicine and the emergence of systematic reviews .................................... 49 Difference between a literature review and a systematic review ............................ 50 Why is a systematic review needed in this area? ..................................................... 51 Chapter 2: Systematic Review Methods ........................................................................ 52 Question synthesis ....................................................................................................... 52 Review objectives ........................................................................................................ 52 Inclusion criteria ......................................................................................................... 52 Population ............................................................................................................................. 53 Interventions .......................................................................................................................... 53 Outcomes............................................................................................................................... 53 2 Types of studies ........................................................................................................... 54 Date of publication time frame .............................................................................................. 54 Language of publications ...................................................................................................... 55 Search strategy ............................................................................................................ 55 Three-step search strategy ..................................................................................................... 55 Example of initial database search strategy in PubMed ........................................................ 56 Study selection ............................................................................................................. 56 Assessment of methodological quality .................................................................................. 57 Threshold for inclusion ......................................................................................................... 57 Agreement between co-reviewers ......................................................................................... 57 Data extraction ............................................................................................................ 57 Data synthesis .............................................................................................................. 58 Summary ..................................................................................................................... 58 Chapter 3: Results .......................................................................................................... 59 Primary and secondary objectives of this review..................................................... 59 Study inclusion process .............................................................................................. 59 Papers identified .................................................................................................................... 59 Title and abstract screening ................................................................................................... 59 Full text review ..................................................................................................................... 59 Included studies .......................................................................................................... 60 Assessment of methodological quality ....................................................................... 61 JBI levels of evidence .................................................................................................. 62 Description of included studies .................................................................................. 64 Demographics .............................................................................................................. 65 Percutaneous drilling and curettage....................................................................................... 65 Percutaneous epiphysiodesis using transphyseal screws ....................................................... 66 eight-Plates ............................................................................................................................ 66 Staples ................................................................................................................................... 67 Overall ................................................................................................................................... 67 Findings of the review ................................................................................................ 68 Absolute leg length discrepancy at skeletal maturity .............................................. 68 Percutaneous drilling and curettage....................................................................................... 68 Percutaneous epiphysiodesis using transphyseal screws ....................................................... 69 eight-Plates ...........................................................................................................................