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PaediatricsRCT

Lateral Opening-Wedge Versus Medial Closing-Wedge Distal Femoral Osteotomy for Adolescent Idiopathic Genu Valgum: A Randomised Controlled Trial

Journal of Pediatric Orthopaedics · 16 Oct 2026

Rigour69/100
Clinical42/100
Impact†48/100

† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.

Why it matters

Once the physis has closed, guided growth is no longer an option for adolescent genu valgum, so knowing that both osteotomy types correct alignment well but change leg length in opposite directions helps with technique choice and family counselling.

The evidence

This single-centre randomised trial compared two distal femoral osteotomy techniques, lateral opening-wedge (LOW) and medial closing-wedge (MCW), in 65 adolescents with idiopathic knock-knee (genu valgum) whose distal femoral growth plates had closed; 62 were analysed. At bone healing, residual mechanical axis deviation was slightly larger after LOW (6.8 mm vs 2.4 mm; difference 4.4 mm, 95% CI 1.5 to 7.3). That difference shrank and lost significance after adjustment for baseline imbalances (3.0 mm, 95% CI -0.4 to 6.5). Function, pain, union time and complications were similar, and LOW lengthened the limb by about 9 mm while MCW shortened it by about 5 mm.

Signed mechanical axis deviation (MAD) at radiographic union: Mean difference 4.4 (95% CI 1.5 to 7.3; millimetres). The interval favours the comparator; the size of the disadvantage needs clinical interpretation.

Why this rigour score?

RCTDesign starting point: 59.5

69/ 100

Raised the score

  • Adequately powered+6
  • Prospectively registered+5.1

Lowered the score

  • Per-protocol analysis only−6
  • No correction for multiple comparisons−3.4

Methods at a glance

Recorded assessment
  • Outcome assessors blindedMet
  • Allocation concealedNot reported
  • Random sequence generatedMet
  • Intention-to-treat analysisNot met
  • Adequate statistical powerMet
  • Prospective registrationMet

Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.

See the full score breakdown
Study design starting point
59.5
Random sequence generation
+2.5
Compared against an accepted alternative
+1.7
Blinded outcome assessment
+3.4
Per-protocol analysis only
−6
Adequately powered
+6
Prospectively registered
+5.1
No correction for multiple comparisons
−3.4
Final rigour score rounded
69 / 100

Study design sets the starting point and a ceiling of 96. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.

Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.

For journal club

1.In an adolescent with unilateral genu valgum and a pre-existing leg-length discrepancy, how would the opposite length effects of opening-wedge (lengthening) and closing-wedge (shortening) osteotomy guide your choice of technique?

2.Only about 60 to 70% of patients said they would have the same procedure again despite high satisfaction scores; how should this shape preoperative counselling about rehabilitation burden, scarring and planned plate removal?

Original publication title

Lateral Opening-Wedge Versus Medial Closing-Wedge Distal Femoral Osteotomy for Adolescent Idiopathic Genu Valgum: A Randomised Controlled Trial

Read original paper