Blount's disease is commonly attributed to an intrinsic, idiopathic defect in 
the posteromedial proximal tibial physis resulting in progressive bowing of the 
leg, intoeing, and lateral knee thrust. Treatment has historically included 
bracing, physeal stapling, or corrective osteotomy, and was determined primarily 
by age at presentation. As we feel the pathology is not necessarily age 
dependent, we have elected to use the technique of guided growth using a lateral 
tension band plate to correct limb alignment as a first-line treatment in all 
patients presenting to our clinic as long as they had growth remaining and no 
evidence of a physeal bar.We identified 17 patients with tibia vara (27 limbs) 
who were managed by means of guided growth of the proximal tibia, from age 1.8 
years to 15.1 years. Clinical and radiographic parameters were followed pre- and 
postoperatively. The response to guided growth was documented as were any 
related complications.Twenty-one (78%) limbs had complete normalization of their 
mechanical axis (middle 50% of knee). Time to correction averaged 13.5 months 
(8-19 months). There were no peri-operative complications. We observed hardware 
failure in 3 patients; 2 with screw breakage and 1 patient with hardware 
migration, none requiring subsequent osteotomy or further treatment. Two 
patients had rebound varus: one is being observed and another has undergone a 
repeat procedure.Patients with pathologic tibia vara present at various ages and 
have historically undergone various treatments ranging from bracing to tibial 
osteotomy based on age at presentation. We have found that guided growth 
utilizing tethering plates can be used effectively as first-line treatment in 
all patients with growth remaining. This minimally invasive method is 
predictable and well tolerated. Recurrent deformity, though unlikely, is easily 
remedied by repeating the process and does not preclude osteotomy if eventually 
needed. Concomitant resolution of ligamentous laxity and inward torsion can be 
anticipated as the mechanical axis is restored to neutral. The only 
contraindications for guided growth include an unresectable physeal bar or 
skeletal maturity.