Guided Growth for Pediatric Ankle Valgus: A Systematic Review of Distal Medial Tibial Hemiepiphysiodesis (DMTH) Outcomes

BACKGROUND AND AIM: Temporary distal medial tibial hemiepiphysiodesis (DMTH) is used to correct pediatric ankle valgus. This review evaluated the radiographic correction achieved, the durability of alignment after implant removal, and safety outcomes. METHODS: PubMed, Ovid MEDLINE, and Embase were searched, and 17 retrospective studies (549 patients and 800 ankles) met the inclusion criteria. Pooled outcome measures included the lateral distal tibial angle (LDTA), tibiotalar angle (TTA), tibiotalar tilt (TT), correction rate, complication rate, and rebound. RESULTS: Preoperative pooled means were TT 13.8, LDTA 78.4, and TTA 76.2 degrees. The pooled radiographic outcomes demonstrated substantial correction, with TT, LDTA, and TTA improving to 0.6, 87.6, and 86.4 degrees, respectively, and the alignment remained largely preserved after implant removal, with corresponding values of TT 3.3, LDTA 85.5, and TTA 85.4 degrees. The overall correction occurred at an average rate of 0.6 degrees per month over a mean duration of 18.6 months before implant removal. Rebound averaged 0.3 degrees/month. Complications were reported in 56 of 508 ankles (11.0%) among the studies that provided complication data, and reoperations were required in 15 of 386 ankles (3.9%) among those reporting reoperation outcomes, most of which were hardware-related. CONCLUSION: DMTH provides consistent correction toward physiological alignment, with modest rebound and low reoperation rates. Heterogeneity and the retrospective design limit generalizability. Standardized outcomes and comparative trials are needed. LEVEL OF EVIDENCE: Level III-therapeutic.