Deficiencies of current methods for the timing of epiphysiodesis

A review of 71 epiphysiodeses with adequate orthoroentgenographic and skeletal-age data was carried out to compare the accuracy of predicting outcome among the methods of Anderson and Green, Menelaus, and Moseley. Differing the methodology did not have a meaningful effect on their similar but limited accuracy. We advocate the use of the Menelaus method, which is simple and based on chronologic age, as it proved as accurate as any other method. The routine use of serial Gruelich and Pyle skeletal-age data could not be shown to increase the accuracy in predicting outcome over serial chronologic-age data, and thus its value in limb-length inequality is limited. Regardless of the method used, unpredictable results occur in a proportion of patients. The patient and parents should be advised of this when planning strategies for limb-length discrepancy.