In pediatric knee guided growth, the correction speed is important, especially when residual growth is limited. However, it is not the only useful parameter for choosing between PETS and tension band plates: predictability, timing of removal, risk of overcorrection, and rebound also matter.
The work by Gupta and colleagues, published online in 2026 in the Journal of Pediatric Orthopaedics, addresses precisely this topic: comparing the effectiveness of PETS — Percutaneous Epiphysiodesis using Transphyseal Screws — with tension band plates, the classic 8-plates, in correcting coronal knee deformities in skeletally immature patients [1].
The authors conducted a systematic review on PubMed, Embase, and Web of Science, including studies from 2004 to January 2025. From 603 identified papers, 13 studies were included: 8 non-comparative and 5 comparative. Methodological quality was assessed using ROBINS-I and MINORS, and the meta-analysis compared the correction speeds of mLDFA, MPTA, and MAD [1].
PETS generally showed faster correction. PETS appeared effective, with reported correction speeds for mLDFA between 0.64 and 1.3°/month, for MPTA between 0.52 and 0.86°/month, and for MAD between 1.3 and 3 mm/month [1]. In comparison with plates, the direction of the effect favors PETS: faster correction for mLDFA, MPTA, and MAD. However, statistical significance was not robustly achieved: the mLDFA result was borderline, while MPTA and MAD remained non-significant. Even in the analysis of idiopathic patients alone, the trend persisted, but without a statistically definitive difference [1].
The available literature thus suggests a higher speed with PETS, without definitively demonstrating overall superiority compared to 8-plates.
In my practice, I routinely use 8-plates and would not change strategy based solely on speed. PETS are a valid technique, and their rationale is strong, but the choice must also consider the timing of the intervention, residual growth, the risk of overcorrection, and rebound.
A second meta-analysis, published in 2025 in BMC Musculoskeletal Disorders, reinforces the theme but does not conclude it. That study included 5 comparative studies involving 473 physes. The authors reported faster angular correction with PETS compared to tension band plates, with an overall mean difference of 0.17°/month; in the femoral subgroup, the difference was 0.21°/month in favor of PETS, and MAD correction was also faster [2]. This is data favorable to PETS, certainly. But here too, we are talking about non-randomized comparative studies, with populations and indications that are not perfectly overlapping [2].
For implant selection, I would therefore look at the predictability of correction in that individual child, in addition to its speed.
8-plates have an obvious drawback: they can be slower. But in practice, they also offer a certain gradualness, a dynamic that many surgeons are familiar with, a generally familiar removal process, and behavior that, while not perfect, has become integrated into our way of planning follow-ups and timing. This does not automatically make them better. It does, however, make them easier to interpret for surgeons who use them often.
PETS, on the contrary, are attractive precisely because they seem more efficient. But efficiency can be a double-edged sword if the window for monitoring correction is narrow. In an adolescent nearing the end of growth, faster correction can be a huge advantage. In a younger child, or in a deformity where prediction is already difficult, rapidity could make the timing of removal more delicate. This is clinical reasoning, not a definitive conclusion from the literature: but it is precisely the kind of caution that these studies, in my opinion, should stimulate.
Another unresolved aspect is rebound. Many guided growth studies measure correction speed very well, but less well what happens afterward: partial loss of correction, need for a new procedure, different behavior between femur and tibia, differences between idiopathic, metabolic, syndromic, or post-traumatic cases. Yet, in real life, the result is not the X-ray on the day of removal. The result is the axis that remains acceptable over time.
PETS are an effective technique and probably faster in many situations. 8-plates remain a solid and well-known solution. With the available data, I see no reason to systematically replace one technique with the other: age, residual growth, deformity location, and surgeon familiarity continue to guide the choice.
Disclaimer
This content is for informational purposes only and does not replace an individual clinical evaluation.
References
[1] Gupta R, Sriwastwa A, Low D, Patel S, Jain V, Parikh SN. Systematic Review of the Effectiveness of Transphyseal Screws for Correction of Coronal Plane Knee Deformities and Meta-analysis of Comparative Studies With Tension Band Plates. J Pediatr Orthop. 2026 Mar 18. doi:10.1097/BPO.0000000000003238. PMID: 41848372.
[2] Sabry AO, Genedy MKA, Abouelwafa S, Khalil AA, Mady O, Mostafa N, Elsayed RAA, Elbarbary H, Hegazy M, Abdelgawad A. Percutaneous epiphysiodesis transphyseal screw versus tension-band plating as hemiepiphysiodesis in treating coronal angular knee deformities: a systematic review and meta-analysis of comparative studies. BMC Musculoskelet Disord. 2025;26:355. doi:10.1186/s12891-025-08540-z. PMID: 40217231.
