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PubMed1994

Tibial osteotomy for genu varum. Indications, preoperative planning, and technique.

Valgus osteotomy of the proximal tibia remains the treatment of choice for the young active patient with a progressively symptomatic varus knee and mild to moderate secondary osteoarthritis. Although the natural history of the varus knee is not well established, it is widely accepted that patients with varus malalignment who develop meniscal injuries or progressive cartilage wear will inevitably develop more severe medial compartment osteoarthritis unless the abnormal mechanics of the knee are corrected.

Bone Malalignment↗
PubMed1981

The correction of primary knee deformities in children.

One hundred and fourteen patients with primary knee deformity either genu varum, genu valgum or combined varus and valgus deformities were treated with serial plaster cylinder casts and wedging for six to nine months. The children were aged between 2 to 13 years, the peak incidence being in the third year of life. Forty-seven of the patients were found to have active or healed rickets but the remaining patients showed no evidence of rachitic lesions. Results showed that serial corrective plaster casts gave a satisfactory cosmetic appearance in 69 patients but the older the patient the less favourable was the result. Eighteen patients were resistant and underwent surgical osteotomy of the femur or tibia; in four instances multiple osteotomy was required. The conclusion was that plaster of Paris casts were a safe and effective method of correcting primary deformity of the knee in the majority of the patients.

Adolescent↗
PubMed1996

Lower limb morphology and risk of overuse injury among male infantry trainees.

The effect of anatomic variation on the risk of overuse injuries has not been adequately evaluated. To determine the association of several common anatomic characteristics (genu varum, genu valgum, genu recurvatum, and lower limb length differences) with risk of overuse injury, we made prospective morphologic measurements of young men prior to beginning 12 week of Army infantry training. The training included frequent running, marching, calisthenics, and other vigorous activities. Lower extremity anatomic landmarks were high-lighted, and front- and side-view photographic slides were taken of the 294 study volunteers. The slides were compute digitized, and the following measures calculated: pelvic width to knee width ratio (to assess genu valgum/varum), quadriceps angle (Q-angle), knee angle at full extension, and lower limb length differences. The cumulative incidence of lower limb overuse injury was 30%. Relative risk of (RR) of overuse injury was significantly higher among participants with the most valgus knees (RR = 1.9). Those with Q-angle of more than 15 degrees had significantly increased risk specifically for stress fractures (RR = 5.4). Anatomic characteristics were associated with several other types of injuries, including pain and nonacute muscle strain due to overuse. This pilot study provides evidence that some lower limb morphologic characteristics may place individuals at increased risk of overuse injuries.

Chi-Square Distribution↗
PubMedDate not supplied

[Is gonarthrosis with varus deformity a clinical entity].

Studies were conducted in a group of patients with varose deformity. The present paper gives the results of indicidual bone metabolism studies conducted on 663 healthy controls and patients with articular disease without genu varum or with varose deformity. In subjects with genu varum intravenous administration of calcium causes the urinary elimination of hydroxyproline and nitrogen to fall. Among the groups under investigation this group of patients excretes the least amount of urine, has a relatively low calciuria and shows the highest retention rate of intravenously administered calcium. Patients with gonarthrosis associated to varose deformity excrete, a day after intravenous administration of calcium, the relatively least amounts of phosphorus, as compared to the healthy controls and other degenerative joint diseases without genu varum. Although the retention of intravenous calcium in the studied group resembles that seen in the process of generalized osteomalacia, no coinciding signs of osteomalacia c ould be found in subjects with gonarthrosis and varose deformity. X-ray examination of patients with genu varum revealed more marked changes in the bone structure, namely sclerosis, necrosis and osteophytes of shapes and sizes other than in gonarthrosis without varose deformity. Epidemiological analysis of 30 patients showed 83.3% of patients to have overweight type I to III according to the Broca formula. Pains in the knee joints started appearing at the mean age of 50 years. A large part of the patients showed the presence of serious varicose syndrome and relapsing phlebitis of the lower limbs. Although the clinical and X-ray pictures make it possible to conisder a larger amount of disease types, we assume that gonarthrosis with varose deformity may be regarded as an isolated clinical entity which refers primarily to a localized bone process.

Aged↗
PubMed1986

"Missing" femoral condyle: an unusual sequela to neonatal osteomyelitis and septic arthritis.

Growth deformities of the distal femur and unusual gait disturbances were observed in four girls who had had neonatal osteomyelitis and septic arthritis. In each case apparent absence or hypoplasia of one of the femoral condyles, as seen on plain radiographs, was associated with marked genu varum or genu valgum. Arthrography showed the apparently missing condyle to be present in a cartilaginous form, with preservation of the articular surfaces. Based on these findings, surgical treatment was limited to corrective osteotomy.

Arthritis, Infectious↗
PubMed1991

Outgrowing trends in the lower extremities of children.

The authors present an overview of the changing biomechanical values in the growing child. They discuss a technique of evaluating total genu varum and genu valgus. A simple tread mat technique is presented.

Biomechanical Phenomena↗
PubMedDate not supplied

Normal development of the tibiofemoral angle in children: a clinical study of 590 normal subjects from 3 to 17 years of age.

In evaluation of genu varum-genu valgum, tibiofemoral (TF) angle and intercondylar (IC) or intermalleolar (IM) distance are commonly measured. In this study, we determined mean values and normal limits for TF angle and IC/IM distance in 590 normal Turkish children (287 girls and 303 boys) aged from 3 to 17 years using clinical methods. We noted a significantly higher degree of valgus angle than that in previous reports. The maximal mean valgus angle was 9.6 degrees at 7 years for boys and 9.8 degrees at 6 years for girls. These differences were considered racial differences between Turkish children and those of other races. Turkish children, aged between 3 and 17 years, exhibited < or =11 degrees physiologic valgus. A measurable varus angle or a valgus higher than 11 degrees during this period should be considered abnormal.

Adolescent↗
PubMed1989

Orthopedic assessment of young children: developmental variations.

Parents often seek orthopedic evaluation of their young children because of apparent abnormalities. However, many of these are simply developmental variations that are part of normal growth and development. Pes planus, or flat foot, is one of the earliest and most common concerns. Torsional variations are also often seen; the presenting complaint may be intoeing (metatarsus adductus, tibial torsion and increased femoral anteversion) or out-toeing (pes calcaneovalgus and external rotation contractures of the hips). Angular variations (genu varum and genu valgum) are also seen frequently in young children. In assessing each finding, consideration must be given to the age at which the finding may be considered within normal limits, methods of examination and documentation, the expected course, findings that may signify abnormality, and appropriate follow-up and referral. An understanding of these common developmental variations in the orthopedic assessment of young children will enable the health care provider to respond to parents' concerns with accurate information and counseling.

Child↗
PubMed1995

Development of the clinical tibiofemoral angle in normal adolescents. A study of 427 normal subjects from 10 to 16 years of age.

We measured the clinical tibiofemoral (TF) angle and the intercondylar (IC) or intermalleolar (IM) distance in 427 normal European children (212 male and 215 female) aged from 10 to 16 years. In our study, girls had a constant valgus (5.5 degrees) and displayed an IM distance of < 8 cm or an IC distance of < 4 cm. By contrast, boys had a varus evolution (4.4 degrees) during the last two years of growth and displayed an IM distance of < 4 cm or an IC distance of < 5 cm. Values above these for genu varum or genu valgum may require careful follow-up and evaluation.

Adolescent↗
PubMed1993

[Deformities of the lower limbs in the frontal plane in children].

Idiopathic genu varum and genu valgum are common problems in pediatric orthopedic practice. Standardized evaluation is essential to compare the deformity with age specific normal ranges. Secondary deformities are infrequent, often unilateral, and progressive with growth. Epiphyseal stapling at adolescence is required only in severe deformities. Patient selection for this procedure is difficult because of uncertainties regarding accurate bone age determination and prediction of final poststapling outcome. Closely spaced evaluations between 10 and 13 years of age are helpful for determining the optimal time for stapling.

Adolescent↗
PubMedDate not supplied

[Gonarthrosis: is the role of pathological statics overestimated?].

UNLABELLED: 57 patients (15 males and 42 females) with osteoarthrosis and/or pathological statics of the knee were examined clinically and radiographically. The question was whether pathological statics (genu varum) act significantly in the pathogenicity of the condition. FINDINGS: a) In a large number of cases it was impossible to determine whether the static deviation were the cause of the osteoarthrosis or whether the reverse were the case. b) The frequency of development of osteoarthrosis in knees with pathological statics was not greater than in those with normal statics. c) The topography of the osteoarthrosis, which one would expect to be a function of the direction of static deviation, was not more frequent in genu varum than in statically normal knees. d) In unilateral genu varum, in some cases the same degree and topography of osteoarthrosis was observed in both knees. e) In a sufficient number of cases, the amount of osteoarthrosis was minimal in relation to the degree of static deviation. f) In genu varum, a deviation was located in the proximal portion of the tibia, whereas in genu valgum, the deviation was located in the distal portion of the femur. The findings "b, c, e" were verified statistically. These findings raise doubts as to the aetiology of pathological statics in the pathogenicity of osteoarthrosis of the knee. Pathological statics alone are not sufficient and probably require other factors for the development of osteoarthrosis.

Aged↗
PubMed2006

[Axial lower limb alignment and knee geometry in patients with osteoarthritis of the knee].

PURPOSE OF THE STUDY: We conducted a retrospective radiographic study to identify and quantify medial and lateral misalignments in candidates for total knee arthroplasty. MATERIAL AND METHODS: We studied a discontinuous series of 101 patients (164 knees) among candidates for total knee arthroplasty seen between 1990 and 2002. We selected a random sample for study. Exclusion criteria were any history of fracture, surgical treatment, rheumatoid disease, or congenital disorder. A first group of 136 genu varum knees was identified in 82 patients (mean age 72 years, mean weight 79 kg). A second group of 28 genu valgum knees was identified in 19 patients (mean age 67 years, mean weight 71 kg). The standard radiograms were digitalized for semi-automatic measurements using the Metros software. We recorded overall deformation, femoral valgus, tibial varus, HKA angle, HKS angle (mechanical/anatomic axis of the femur) and angle C (horizontal inclination of the ankle to the ground). All measures were compared between each other for each patient to search for relations. RESULTS: In the genu varum group (136 knees), mean overall deformation was 9 degrees , mainly due to tibial misalignment (5.5 degrees ) with a 1 degrees femoral valgus component. The HKS angle was 6.3 degrees , and lateral joint gap 4.3 degrees ; the C angle was 4 degrees . Overall varus followed tibial varus (p<0.01). Ankle inclination followed tibial varus (p<0.01). In the genu valgum group (28 knees), overall deformation was 4.2 degrees , mainly due to femoral misalignment (5.6 degrees) with 1 degrees tibial varus and a medial joint gap of 2 degrees . The HKS angle was 4.7 degrees and the mean C angle -4 degrees . Overall valgus was related to femoral valgus (p<0.001). Tibial varus was greater with greater femoral valgus (p<0.01). In both groups, the HKS angle was smaller with greater femoral valgus. DISCUSSION: Semi-automatic measurements on digitalized films enabled excellent reproducibility. Causes of error were related to limb rotation at acquisition. This study showed that genu varum worsens because of tibial wear followed by ligament distension, while for genu valgum, worsening predominantly results from femoral wear. The ankle joint line was nearly horizontal in one-third of the limbs, even when there was a major misalignment of the lower limb. The HKS angle was quite variable in both morphotypes, but was smaller with greater femoral valgus in both groups. CONCLUSION: Measuring all components involved in medial and lateral knee misalignment is very useful for understanding the morphotype of each individual knee before performing osteotomy or implanting a knee prosthesis.

Aged↗