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Guided growth is one of the most utilized surgical techniques for managing limb deformity in skeletally immature patients. Our understanding of this technique and the types of implants utilized have evolved over the past century. Many of the known risks of this surgery, such as over-correction, under-correction, and rebound deformity, are the same risks initially described when hemiephysiodesis and guided growth techniques were first published. The staple has been a powerful tool for deformity correction but its high rates of implant backout and breakage as well as unpredictable rates of premature physeal closure after removal have contributed to this implant being used less frequently today. Many studies on percutaneous transepiphyseal screws (PETS) are promising but have little follow-up so the risks of this technique with regard to premature physeal closure are not well understood. Tension band plating is currently the most utilized method. However, in specific patient subgroups, the perioperative complication and failure of correction rates are high. Despite the abundance of literature on these techniques, our understanding of guided growth is still quite limited as most studies are small and do not follow patients to skeletal maturity. Guided growth surgery also can restore the mechanical axis of the limb while leaving patients with significant residual diaphyseal or peri-articular deformity and the implications of these secondary deformities have not been studied.