Most Knee Deformities from Healed Rickets Self-Correct in Children Under 8, Study Finds
Egypt: A new study published in the Journal of Pediatric Orthopaedics suggests that most coronal knee deformities in children under 8 years of age with healed nutritional rickets improve on their own, without the need for surgical intervention. The findings support a more conservative, observation-based approach to managing such deformities during early childhood.
Led by Dr. Mostafa M. Baraka from the Division of Pediatric Orthopedics, Ain Shams University, Cairo, Egypt, the research aimed to understand how coronal plane knee deformities evolve over time in children who have recovered from nutritional rickets—a condition still widely prevalent in many parts of the world due to vitamin D deficiency.
The prospective study included 57 children (109 knees), with an average age of 6.1 years, who were monitored over 12 months. Researchers recorded changes in the tibiofemoral angle through radiographic evaluations and measured caregiver satisfaction through structured questionnaires. Key variables such as the child’s age, sex, deformity severity, type (valgum or varum), and whether the deformity was present in one or both knees were analyzed for their impact on remodeling outcomes.
The study led to the following findings:
- Children who showed complete spontaneous correction had a mean age of 4.9 years, while those with failed remodeling had a mean age of 8.4 years.
- Children older than 8 years were over 16 times more likely to have persistent deformities compared to those aged eight or younger (Odds Ratio: 16.4).
- Valgum deformities exceeding 16.5° and varum deformities over 13° had a lower likelihood of remodeling spontaneously.
- No significant association was found between remodeling outcomes and the child’s sex, deformity direction (valgum or varum), or whether the condition was unilateral or bilateral.
- Radiographic assessments showed excellent inter- and intra-observer reliability, confirming the accuracy of measurements.
- Younger age and less severe deformity angles were identified as strong predictors of successful spontaneous correction.
The authors emphasize that these findings could lead to a shift in current treatment practices. Rather than proceeding with early surgical correction, children under 8 years old with moderate coronal knee deformities due to healed rickets may benefit more from a year of monitored observation. This approach could reduce unnecessary surgical procedures, lower healthcare costs, and improve the overall risk-benefit ratio for young patients.
The authors concluded, "The study advocates for a more individualized and conservative strategy in treating pediatric knee deformities associated with healed nutritional rickets—one that recognizes the body's inherent ability to correct moderate malalignments during early growth."
Reference:
Baraka, Mostafa M. MD, PhD; Samir, Shady MD, PhD; Mahmoud, Shady MD, PhD; El-Sobky, Tamer A. MD, PhD. Most Coronal Knee Deformities of Healed Nutritional Rickets Under 8 Years of Age Remodel Spontaneously: Building Evidence for Practice Change. Journal of Pediatric Orthopaedics ():10.1097/BPO.0000000000003028, July 3, 2025. | DOI: 10.1097/BPO.0000000000003028
