Genu valgus is defined as the angle formed at the knee between the femur and tibia in which the knee angulates toward Sign in to download full-size image. Genu valgum is a common entity that is most often physiologic in nature and part of the normal developmental change in Sign in to download full-size image. PDF | Background Idiopathic genu valgum is a frequently diagnosed growth disorder in adolescence. Whenever the possibilities of Download full-text PDF.
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Genu Valgum - Download as Word Doc .doc), PDF File .pdf), Text File .txt) or read online. deformity of knee. Genu valgum: º. Patella alta: •. Abnormal position of patella in relation to femur. •. Associated with subluxation or displacement of. How to treat patellofemoral knee pain. Genu ValgoAnkle PainFoot Exercises Physical TherapistKnock Knees CorrectionFeel BetterBody PartsWorkout Programs.
These relationships can be used to characterize the source and severity of valgus malalignment, as advocated by Paley et al. C, Valgus deformity in the tibia is characterized by a medial proximal tibial angle MPTA greater than 90 degrees. D, Valgus deformity in the femur is characterized by a lateral distal femoral angle LDFA less than 85 degrees.
E, Combined deformity. Orthop Clin North Am ; Mencio, MD physis opposite the apex of the compensated for by premature clo- Typically, the apex of deformity in deformity, around which angulation sure of the physis on the same side, genu valgum is at the level of the can be corrected.
Correction is predicated on contin- degrees is recommended to achieve Osteotomy at this level in either the ued growth in the contralateral half of the desired effect if staple removal is distal femur or the proximal tibia is the physis.
Thus, the ability to predict necessary. Adolescent girls with a generally not feasible in skeletally remaining growth and its effect on skeletal age of 11 years and boys immature individuals. Thus, the angular deformity is crucial to achiev- with a skeletal age of 12 years are osteotomy must be performed at a ing a successful outcome. Bowen et generally the most suitable candi- level different from that of the defor- al25 developed a method that allows dates for this procedure.
Therefore, it must be designed correction of angular deformity to be seal stapling is not recommended not only to correct angulation but also correlated with linear growth with for children less than 10 years old to compensate for translation in order use of the Green-Anderson growth- because of the uncertainty of the to properly realign the extremity.
Alternatively, angular epiphysiodesis. However, the procedure is to fine-tune alignment or to be repo- not reversible, and in conditions in Osteotomy sitioned in the event of neurovascu- which growth may be atypical, mis- Osteotomy is probably the most lar compromise.
While osteotomy neurovascular complications after deformity. Therefore, when skeletal may be done at any age, it is usually osteotomy are probably more com- growth is not predictable, as in renal reserved until patients are near skele- mon than recognized. They include osteodystrophy, rickets, and other tal maturity. As with the other meth- compartment syndromes, ischemia metabolic conditions that cause gen- ods of correction of valgus deformity, due to stretch or compression of eralized bone involvement, epiphy- the goal of osteotomy is restoration of the anterior tibial artery, and neu- seal stapling may be a better option.
If osseous deformity is gener- oneal nerve. The risks can be Clarke26 in , this procedure is alized, correction at multiple sites reduced by avoiding acute valgus- intended to halt physeal growth by within the extremity and occasionally to-varus realignment when deformi- creating a peripheral bracket around even within a single bone may be nec- ty is particularly severe, routinely the physis that mechanically essary.
Generally, correction can be performing prophylactic anterior- impedes longitudinal growth. If there osteotomies. Relative Merits of Surgical occurred and if staple removal can The specifics of realignment Procedures be done without damaging the osteotomies are beyond the scope of Both epiphyseal stapling and par- growth plate in the process. The important con- tial epiphysiodesis can be performed Restoration of growth is usually cept is that correction should be with less morbidity than is associ- attended by a rebound phenome- estab-lished as close to the center of ated with osteotomy.
Fur- physis. Although this is partially translational deformity in the bone. The patients metabolic unnecessary in the former and inef- femur or the proximal tibia, correc- profile must be stabilized as a pre- fective in the latter. Children more tion occurs at the appropriate level requisite to surgical treatment. Summary tance of more than 10 cm are un- Posttraumatic genu valgum after likely to improve spontaneously a proximal tibial metaphyseal frac- Genu valgum is a common condi- and usually require operative treat- ture generally corrects sponta- tion in children.
Physiologic vari- ment. The goal of treatment is neously over the course of 2 to 4 ants predominate and do not restoration of normal mechanical- years,29 and early osteotomy should require treatment.
Pathologic genu axis alignment, which, depending be avoided. Knowledge of be achieved by epiphyseal stapling, arthrodesis or by osteotomy, de- the natural history of the develop- partial epiphysiodesis, or oste- pending on the severity and the ment of the tibiofemoral angle is otomy.
If symptoms are prolonged and pronounced or hereditary, doctors often use orthotic shoes or leg braces at night to gently move a child's leg back into position. If the condition persists and worsens later in life, surgery may be required to relieve pain and complications resulting from severe or hereditary genu valgum.
Available surgical procedures include adjustments to the lower femur and total knee replacement TKR.
Weight loss and substitution of high-impact for low-impact exercise can help slow progression of the condition. With every step, the patient's weight places a distortion on the knee toward a knocked knee position, and the effect is increased with increased angle or increased weight.
Even in the normal knee position, the femurs function at an angle because they connect to the hip girdle at points much further apart than they connect at the knees. Physiologic vari- ment.
The goal of treatment is neously over the course of 2 to 4 ants predominate and do not restoration of normal mechanical- years,29 and early osteotomy should require treatment. Pathologic genu axis alignment, which, depending be avoided. Knowledge of be achieved by epiphyseal stapling, arthrodesis or by osteotomy, de- the natural history of the develop- partial epiphysiodesis, or oste- pending on the severity and the ment of the tibiofemoral angle is otomy. Nonoperative treat- Acknowledgments: The authors are grate- ful to Dorothy Cochrane, Debbie Chessor, long-standing metabolic disorders is ment has no place in the manage- and Holly Quick for their assistance in the generally a complex deformity and ment of either physiologic or preparation of the manuscript.
References 1. Salenius P, Vankka E: The development 9. Taylor SL: Tibial overgrowth: A cause J of genu valgum. Clin Orthop ; 2. Davids JR, Fisher R, Lum G, et al: Angu- encing gait in childhood: A study of the fractures of the proximal metaphysial lar deformity of the lower extremity in angle of gait, tibial torsion, knee angle, region of the tibia in children.
J Bone children with renal osteodystrophy. J hip rotation, and development of the Joint Surg Br ; Pediatr Orthop ; Clin Orthop J Pediatr Weber BG: Fibrous interposition caus- in the treatment of cerebral palsy. Clin 4. Howorth B: Knock knees: With special ing valgus deformity after fracture of Orthop ; Clin the upper tibial metaphysis in children. J Bone Joint Surg Br ; J Bone Joint Surg Am ; Growth disturbances following distal ology of valgus angulation after me- J taphyseal fractures of the tibia in J Pediatr Orthop ; al: Stapling of the knee in juvenile 6.
J Pediatr Orthop ; about the knee associated with non- Green NE: Tibia valga caused by asym- Instr Course Lect ; 7. Cozen L: Fracture of the proximal por- tibial metaphysis.
J Pediatr Orthop ; Staheli LT: The lower limb, in valgus deformity. Surg Gynecol Obstet Posttraumatic tibia valga: A case Pediatric Orthopaedics, 3rd ed.
Jackson DW, Cozen L: Genu valgum as demonstrating asymmetric activity at delphia: JB Lippincott, , pp a complication of proximal tibial me- the proximal growth plate on tech-