Growth modulation can be a helpful treatment for conditions like knock knees (genu valgum) in children, especially when they still have significant growth remaining |Photograh used for representational purpose only
| Photo Credit: Wikimedia commons
When it comes to children’s health, two key terms are often used together – growth and development. While growth refers to physical changes like height and weight, development looks at milestones such as walking, talking and behaviour. Together, they are used to track a child’s overall physical, emotional, cognitive, and behavioural progress from infancy to adolescence.
It is a well-accepted fact that no two children are alike, hence the pace of their growth and development stages differ. Some children may develop conditions like knock knees, bow legs and other such deformities. Informed parents of these children now often ask about growth modulation.
Let us understand what growth modulation means, how it works and what outcomes to expect.
What is growth modulation?
Growth refers to an increase in dimension, such as height or length, while modulation means controlling, altering, or regulating something. When parents discuss growth modulation, it implies they are seeking to guide or influence certain aspects of their child’s growth. Growth modulation is an orthopaedic technique used to align bones and soft tissues in children with misalignment or deformities.
Children have growth plates—soft areas at the ends of bones – where new growth such as gaining height occurs till adolescence. If one side of the growth plate is damaged or restricted, the other side continues to grow,which can result in a deformity. Growth modulation uses this principle, but for correction rather than causing damage.
For example, in genu valgum (knock knees), there is inward angulation at the lower end of the femur (thigh bone). By slowing growth on the inner side of the growth plate and allowing the outer side to grow, the deformity gradually corrects itself over a period of about eight or nine months.
Types of growth modulation and tools used
Growth modulation can be achieved either permanently or temporarily. Permanent growth modulation (hemiepiphysiodesis) involves completely stopping growth on one side of the plate. However, as this is irreversible, it is now rarely used . Temporary growth modulation is a more advanced technique that uses implants (plates or screws), which can be removed after correction to allow normal growth to resume.
The procedure is performed using several tools. Staples were once common, but are now rarely used due to their rigidity and risk of bending or breaking. The 8-Plate, a specialised tension band plate popularised by Peter Stevens in 2007, is effective but requires a 1.5–2 cm incision and can sometimes be prominent. The PET Screw is currently the preferred method . Made of titanium, this screw is inserted through a single stitch. Being minimally invasive, it allows faster recovery with less discomfort. . The child can walk the next day, return to school within a few days, and resume play within two weeks.
When is growth modulation recommended and what are its benefits?
A paediatric orthopaedic surgeon will usually recommend growth modulation if a child has a significant deformity, such as knock knees or bow legs (tibial dysplasia). The procedure is most effective when the child has at least two years of growth remaining and the growth plates are healthy and undamaged by trauma (accidents or fractures) or infection.
Growth modulation has gained wide acceptance due to its many advantages over traditional open surgery. These include a small incision, no need for plaster, almost immediate return to weight-bearing activities such as standing or walking, and a fast recovery that allows the child to return to school within days and resume play within a few weeks. The procedure causes minimal disruption to the child’s daily routine and is far less painful than conventional surgery.
In addition to correcting angular deformities, growth modulation can also be used to correct limb length discrepancies and certain spinal deformities. Overall, growth modulation is a safe, effective, and minimally invasive technique that helps children regain proper alignment while allowing them to continue enjoying their normal activities. When performed at the right age, it offers excellent outcomes and supports a positive, active childhood.
(Dr. Taral Nagda is paediatric orthopaedic surgeon, Narayana Health SRCC Children’s Hospital, Mumbai. taralnagda@gmail.com )
Published – August 14, 2025 03:00 pm IST
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