1. ROCK Complex Case of the Month
Jason Rhodes, MD
Stephanie W. Mayer, MD
Jay Albright, MD
Children’s Hospital Colorado

2. HPI 12 yr old African-American male, BMI: 32.5 kg/m2
Bilateral knee pain, worsened with activity, for past several months
Bilateral clinical genu varum on exam
No prior surgical intervention

3. Initial Presentation

5. Metaphyseal-diaphyseal angles:
Varus deformity in the proximal tibia with medial tibial physeal changes consistent with Blount’s disease
Metaphyseal-diaphyseal angles:
Left 6◦
Right 5 ◦
Anatomic axis
Left 6◦ varus
Right 2◦ varus
Lucency in bilateral media femoral condyle concerning for OCD

6. Left knee MRI evaluation consistent with Hefti Stage 4

7. Right knee MRI evaluation consistent with Hefti Stage 4

8. Plan Proximal tibial growth modulation
Arthroscopic transchondral drilling
1.1 mm chondral dart drill with guide used
20 drill holes in 12 X 14 mm OCD = 12 drill holes/cm2

9. Right knee
Left knee

10. Postoperative

11. 3 mo post op: no knee pain; radiographs show significant OCD healing with subchondral bone formation
9 mo post op: knee pain completely resolved and back to full activities
2 yr post op: complete healing of OCD’s and correction of genu varum and back to full activities with no pain