1. Introduction
Pediatric lower limb angular deformities, such as genu varum (bowlegs) and genu valgum (knock-knees), require timely intervention to prevent joint degeneration and improve gait and aesthetics. In growing children, guided growth, also known as temporary hemiepiphysiodesis, is a minimally invasive solution that leverages the child’s remaining growth potential to correct deformity gradually.
Among the available implants for this technique, two are commonly discussed,The widely recognized eight-plate, The cost-effective alternative, reconstruction plate.
2.What Are the Eight-Plate and Reconstruction Plate?
Eight-Plate: A titanium tension-band plate with two holes, designed to act like a flexible hinge at the physis. Screws are placed proximal and distal to the growth plate. It’s widely used in guided growth due to its versatility and effectiveness.
Reconstruction Plate: A traditional 3.5 mm straight plate originally used for fracture fixation. Recently repurposed for guided growth due to its low cost, especially in resource-limited settings.
3.Definition: What Conditions Does the Eight-Plate Treat?
The eight-plate is used for coronal plane angular deformities of the knee, including:
Genu valgum (X-legs)
Genu varum (O-legs)
Other conditions such as Blount disease, rickets, or skeletal dysplasias
The principle involves tethering one side of the physis, allowing the opposite side to grow freely and realign the bone gradually.
4.Origin, Indications, and Contraindications of the Eight-Plate
Origin:
First described by Stevens in 2007, the eight-plate was designed to overcome complications associated with staples and transphyseal screws, such as irreversible physeal arrest and implant migration.
Indications:
Skeletally immature children
Progressive or significant angular deformities
Idiopathic or syndromic etiologies
Contraindications:
Closed growth plates
Active infection at the site
Severe obesity (relative caution)
Severe neuromuscular deformities requiring complex correction
5. Eight-Plate vs. Reconstruction Plate: Comparative Advantages
| Feature | Eight-Plate | Reconstruction Plate |
| Cost | Expensive (up to 20× more costly) | Very affordable |
| Design | Tension-band; allows physiological motion | Rigid plate; fixed-angle |
| Ease of Use | Pre-contoured and flexible | Requires manual contouring |
| Implant Migration | Rare due to dynamic nature | More prone without careful technique |
| Soft Tissue Compatibility | Slim, less irritation | Thicker, may impact motion |
6. Clinical Results and Outcomes
The 2024 meta-analysis by Dwipayana et al. compared both implants in 181 patients (339 knees). Key findings include:
Angular Correction:
LDFA and MPTA correction rates were comparable between both implants (p > 0.27).
Correction rate: ~8–9° on average in both groups.
Implant Failure:
Failure rate not significantly different (OR = 0.36; p = 0.28).
Most failures were due to technical factors or poor patient selection (e.g., obesity, “sick” physis).
Rebound Rate:
Equal (two cases in each group), no significant difference (p = 0.44).
Complications:
Similar rates (~2–3%), including screw loosening, superficial infections, and overcorrection.
Reconstruction plate had slightly more soft tissue irritation due to plate thickness.
Despite the higher cost, the eight-plate may offer better biocompatibility and is less technically demanding. The reconstruction plate, however, achieves similar correction outcomes at a fraction of the cost—making it attractive for developing countries or public hospitals.
7. Conclusion
Both the eight-plate and the reconstruction plate are effective tools for guided growth in pediatric angular deformity correction. While the eight-plate remains the gold standard for its biomechanical design and soft tissue friendliness, the reconstruction plate has proven to be a viable, cost-effective alternative—provided surgical technique and patient selection are appropriate.
Summary Recommendations
Eight-Plate for patients with complex deformities, syndromic conditions, or in private healthcare systems.
Reconstruction Plate for idiopathic deformities in resource-limited settings, with careful technique and follow-up.
The future of pediatric orthopedic care lies in safe, accessible, and affordable technologies—and both these implants have a place in that vision.