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At least 127 records · Page 7Linked to original sources
PubMed2026

The knee-ankle link: impact of knee varus severity on distal joint malalignment and concomitant pathologies.

BACKGROUND: Knee varus deformity is traditionally managed as an isolated joint pathology; however, persistent distal symptoms following proximal realignment suggest a more extensive kinetic chain dysfunction. The degree to which knee varus severity dictates distal malalignment and secondary pathologies remains poorly quantified in the current literature. METHODS: This systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines (PROSPERO: CRD420261363327). A comprehensive search of PubMed, Embase, Web of Science, and the Cochrane Library was performed from inception to April 2026. Studies examining the relationship between knee varus (HKA angle) and radiographic distal alignment or pathologies were included. Data synthesis utilized random-effects models, with prevalence analyzed via generalized linear mixed models (GLMM). RESULTS: Fourteen studies were included in the final synthesis. While pooling of continuous radiographic parameters was limited by high statistical heterogeneity in Talar Tilt (I2 = 96.5%), individual large-cohort data (Huang et al.) indicated that severe knee varus (HKA > 10°) was associated with increased odds of concomitant ankle osteoarthritis (OR 2.29; 95% CI 1.28-4.11) and a specific cohort prevalence of 37.1%. Furthermore, single-arm prevalence data revealed divergent trends across different study populations, with compensatory hindfoot valgus reaching 69.9% in some cohorts and rigid varus up to 63.9% in others. CONCLUSIONS: Severe genu varum is associated with distal kinetic chain alterations and concomitant ankle pathologies. However, due to the extreme heterogeneity and divergent distal adaptations observed across different cohorts, standardized knee-centric protocols may be insufficient. Further longitudinal and interventional studies are required to establish phenotype-specific rehabilitation guidelines.

Humans↗
PubMed2000

Hereditary disorders mimicking and/or causing premature osteoarthritis.

Osteoarthritis is the most common joint disease, causing considerable disability and impairment of quality of life. Hereditary osteochondrodysplasias and some inborn errors of metabolism may mimic or cause premature osteoarthritis. Osteochondrodysplasias usually cause joint deformities, such as coxa vara or genu varum, which can cause abnormal biomechanics. In most of these disorders, the articular cartilage is originally defective as a result of genetically determined collagen or matrix protein abnormalities, or the deposition of mucopolysaccharides. In the case of inborn errors of metabolism, the pathological process affects healthy articular structures, causing secondary osteoarthritis. In alkaptonuria, the pathological deposition of polymerized homogenistic acid causes defective changes in cartilage, articular capsule and tendons. In Wilson's disease, the premature osteoarthritis might be caused by the copper deposition. It is worth paying attention to these rare disorders, even when they are mild or incomplete, because early diagnosis can lead to prevention and effective treatment. In addition, research is discovering the specific gene defects and molecular abnormalities that are responsible for disease expression. This may in turn lead to opportunities for prenatal diagnosis; thus, genetic counselling and gene replacement therapy may be a realistic possibility in the near future.

Adolescent↗
PubMedDate not supplied

[Ultrasound in the early diagnosis of congenital dislocation of the patella].

INTRODUCTION: Congenital dislocation of the patella is defined as lateral dislocation of the patella present at birth, impossibility of closed reduction and diagnosis before the age of 10 years. We report about a rare case of a bilateral congenital dislocation of the patella. CASE REPORT: Physical examination of an eight-month- old boy showed bilateral knee flexion contractures associated with moderate genu varum. On both sides the patella could not be palpated easily. Radiographic diagnosis could not show the patella as the patella normally ossifies later. Ultrasound examination located the patella lateral to the lateral femoral condyle on both sides. Closed reduction was impossible. An open reduction with division of the lateral soft tissues, lateral release, and derotation of the quadriceps femoris and refining of the medial structures was performed. After cast removal the patellae were both located in the intercondylar grooves as confirmed by clinical and ultrasound examinations of both knees. Active and passive exercises were started. CONCLUSION: Failure of internal rotation of the myotome which contains the quadriceps femoris and the patella is the etiology of congenital dislocation of the patella. The quadriceps acts as flexor, exerting a valgus stress on the knee, causing external rotation of the tibia. Diagnosis is often delayed because of the lack of pathological findings on plain radiographs. Early diagnosis is enabled by ultrasonography. Surgical treatment is necessary and results are good, as long as there are no secondary changes.

Contracture↗
PubMed2003

Management of musculoskeletal complications of hemophilia.

Prophylactic treatment from ages 2 to 18 years could prevent the development of hemophilic arthropathy if the concentration of the patient's deficient factor is kept from falling below 1% of normal. Early treatment is of paramount importance because the immature skeleton is very sensitive to the complications of hemophilia. Major hemarthrosis and chronic hemophilic synovitis should be treated aggressively to prevent hemophilic arthropathy. When advanced hemophilic arthropathy is present with severe disability, the aim should be to restore function while minimizing the risk to the patient. Joint debridement is an effective method to achieve this goal, especially around the elbow or ankle, and can be considered an alternative to knee replacement in the younger age groups. Proximal tibial valgus osteotomy is a reliable treatment method for painful genu varum of the mobile hemophilic knee. Supramalleolar tibial varus osteotomy is an attractive alternative to the more commonly used surgical option of arthrodesis. Finally, joint replacement can usually be relied on to restore both mobility and function in a diseased joint. The potential benefits of joint replacement must always be weighed against the long-term sequelae, however, especially loosening and consequent revision surgery.

Adolescent↗
PubMedDate not supplied

[Predictors of tibial head transposition in the therapy of varus knee osteoarthritis].

PURPOSE: The aim of this study was to find predictors for the clinical outcome in patients who underwent a high tibial osteotomy (HTO). METHOD: Between 1984 and 1996 a high tibial valgus osteotomy was performed in 155 patients with genu varum. 133 HTO patients were available for follow-up at an average postoperative time of 9.3 +/- 3.0 years. The degree of osteoarthritis was evaluated by radiological (Kellgren) and arthroscopic scoring systems (Outerbridge). Survival time of HTO was estimated using Kaplan-Meier survivorship analysis. RESULTS: The survival rate of HTO was 95 % after 5 years and 77 % after 10 years. In the medial compartment of knee joints with a preoperative Outerbridge stage III/IV or Kellgren stage III/IV the survival rate of HTO was significantly lower when compared to stages 0/I/II (p < 0.05). Age, sex, tibial malalignment and severity of osteoarthritis in the lateral compartment had no influence on survival rates. The pre-postoperative comparison of radiologically visible signs of osteoarthritis showed mainly either no (46.5 %) or only small (50.5 %) progression. We found that patients who underwent a HTO had good and very good clinical outcomes. CONCLUSION: We identified severity of preoperative radiological osteoarthritis and intraoperative chondromalacia as predictors of survival rate.

Female↗
PubMed1995

Nutritional rickets in Calabar, Nigeria.

The features of 20 cases of nutritional rickets who presented at the University of Calabar Teaching Hospital, Calabar in south-eastern Nigeria over a 9-year period (January 1985-December 1993) are presented. The aim is to compare them with those in the only other reports from Nigeria between 18 and 42 years ago from Ibadan in the west of the country. The ages at presentation ranged between 6 months and 5 years with no sex preponderance. Most of the children were well nourished with the major features being delay in walking, swollen wrists and ankles and genu varum. The majority of cases in the present study occurred among children of elite and middle class parents who deprived their children of sunshine by keeping them indoors most of the day while they were at work. Reasons for the comparatively low prevalence of rickets in Calabar are social and cultural factors which enhance the exposure of children to sunlight. In addition, the relative availability of seafood and vegetables in this coastal city enhances rickets prevention.

Child, Preschool↗
PubMed1985

Surgical aspects of limb deformity in hypophosphatemic rickets.

Our assessment of the surgical correction of bowleg deformity in eight patients with sex-linked dominant hypophosphatemic rickets showed the best results in patients having staged, proximal tibial osteotomies at completion of growth. Lack of medical therapy was associated with recurrent genu varum or markedly delayed union. Undercorrection may be prevented by using the hip-knee-ankle axis to plan the realignment procedure.

Bone Diseases, Developmental↗
PubMed2001

Clinical and radiographic evaluation of bowlegs.

Lower extremity bowing is a normal physiologic process that commonly occurs in walking children under the age of 2 years. After this age, any significant amount of residual bowing is abnormal and may be due to infections, traumatic physeal injuries, genetic predisposition, metabolic factors, or a combination of these. Of the pathologic conditions, infantile Blount's disease is the most common and is predominantly found in obese children with an early onset of walking. Because of its frequency in occurrence and general tendency for spontaneous resolution, physiologic genu varum must be clearly distinguished from other pathologic processes that result in bowleggedness. Treatment of the latter cases may consist of early bracing or surgery.

Achondroplasia↗
PubMed1984

The evolution and histopathology of adolescent tibia vara.

This clinical, radiographic, and histologic study clarifies the evolution of the distinct clinical and radiographic disorder known as adolescent tibia vara (Blount's disease). Although previous reports have suggested that the disorder occurs in a limb that has been normally aligned until adolescence, we have found that most children with adolescent tibia vara maintain a mild degree of infantile physiologic genu varum. Then, concurrent with the adolescent growth spurt, certain children with predisposing factors, such as obesity, extreme activity, or rapid growth, injure the posteromedial physis as a result of repetitive trauma due to normal use of a limb already in mild varus. The result is growth suppression, further varus, and a classic radiographic presentation. Histologic examination in two cases suggests injury to the growth plate as demonstrated by fissuring and clefts in the physis as well as fibrovascular and cartilaginous repair tissue at the physeal-metaphyseal junction. Transverse trabeculae, resembling growth arrest lines, were noted in the adjacent metaphysis; however, true bony bridging of the growth plate was not seen. Recommended treatment is corrective osteotomy below the growth plate.

Adolescent↗
PubMed1984

Late-onset tibia vara: a comparative analysis.

We reviewed the clinical and radiographic characteristics and response to treatment of 11 children (16 knees) with idiopathic late-onset tibia vara (adolescent Blount's disease) followed for an average of 5.7 years (range, 3-10 years). The clinical characteristics were very consistent: black race; 2:1 male predominance; normal height; marked obesity; knee pain as the primary presenting complaint; and slowly progressive genu varum deformity that averaged 19 degrees (range, 10-45 degrees). Radiographically, the epiphyses were wedge shaped owing to medial flattening, the physes were irregular in thickness, and there was minimal, if any increased prominence of the proximal medial metaphysis. Nineteen proximal tibial valgus and diaphyseal fibula osteotomies were performed on 15 knees. There was a 50% rate of recurrent deformity in males with clinical onset at less than or equal to 10 years of age. Females and older males had no recurrences. Histopathologic studies of the physis performed on one case demonstrated abnormal cellular islands of hyaline cartilage, small foci of necrotic cartilage, prominent intertrabecular vascularity, and premature medial physeal closure. These data support late-onset tibia vara as a distinct entity closely related to the infantile form. They also suggest three specific forms of tibia vara based on the age at clinical onset: infantile (0-3 years), juvenile (4-10 years), and true adolescent (11 years or older). The juvenile group is characterized by a high rate of recurrence following surgical correction, whereas the others are not.

Adolescent↗
PubMedDate not supplied

Oblique tibial osteotomy for Blount's disease (tibia vara).

Nine oblique proximal tibial osteotomies were performed on six children with genu varum, all but one of whom had Blount's disease. The osteotomy was a single-plane cut allowing simultaneous correction of varus and internal rotation and permitting postoperative cast wedging if necessary to improve position. All osteotomies healed within 10 weeks. The major complications were three episodes of weakness of the extensor hallucis longus, two of which resolved in 4 days and one of which resolved only partially. We were able to combine the osteotomy with other procedures, such as epiphyseal bar resection. All nine osteotomies achieved the desired correction of deformity.

Adolescent↗
PubMed1981

Autosomal hypophosphataemic bone disease responds to 1,25-(OH)2D3.

We diagnosed non X-linked hypophosphataemic bone disease in a 38-month-old girl. Findings included: genu varum, shortened stature, fasting hypophosphataemia (2.3-2.5 mg/100 ml; 0.74-0.81 mmol/l), diminished theoretical renal threshold for phosphate (TmP/GFR), and osteomalacia without rickets. One patient (the father) had fasting hypophosphataemia (2.3-2.7 mg/100 ml; 0.74-0.87 mmol/l) and low TmP/GFR without osteomalacia or shortened stature. Treatment of the girl with 1,25-(OH)2D3 (1 microgram a day) raised the level of serum phosphorus, improved tubular reabsorption of phosphate, and healed the bone deformity; this combination of responses is not present in X-linked hypophosphataemia. There was no correction of hypophosphataemia or TmP/GFR with 1,25-(OH)2D3 treatment (1-3 micrograms a day) in the father.

Adult↗
PubMed1983

Osteoarthrosis in runners with knee pain.

A clinical and radiological study of the knee joints of twenty middle and long distance runners, complaining of knee pain, was carried out. Osteoarthrosis of varying degree was found in six of the runners. A torn meniscus requiring surgery was found in one athlete, and another had considerable ligamentous laxity - both of these conditions predispose to the development of degenerative changes. Degenerative changes were significantly associated with the presence of genu varum (p less than 0.01) and history of severe injury (p less than 0.05). The number of years spent training was significantly greater in the affected group than in the unaffected group (p less than 0.05).

Adult↗
PubMed2004

Relation between running injury and static lower limb alignment in recreational runners.

OBJECTIVES: To determine if measurements of static lower limb alignment are related to lower limb injury in recreational runners. METHODS: Static lower limb alignment was prospectively measured in 87 recreational runners. They were observed for the following six months for any running related musculoskeletal injuries of the lower limb. Injuries were defined according to six types: R1, R2, and R3 injuries caused a reduction in running mileage for one day, two to seven days, or more than seven days respectively; S1, S2, and S3 injuries caused stoppage of running for one day, two to seven days, or more than seven days respectively. RESULTS: At least one lower limb injury was suffered by 79% of the runners during the observation period. When the data for all runners were pooled, 95% confidence intervals calculated for the differences in the measurements of lower limb alignment between the injured and non-injured runners suggested that there were no differences. However, when only runners diagnosed with patellofemoral pain syndrome (n = 6) were compared with non-injured runners, differences were found in right ankle dorsiflexion (0.3 to 6.1), right knee genu varum (-0.9 to -0.3), and left forefoot varus (-0.5 to -0.4). CONCLUSIONS: In recreational runners, there is no evidence that static biomechanical alignment measurements of the lower limbs are related to lower limb injury except patellofemoral pain syndrome. However, the effect of static lower limb alignment may be injury specific.

Adult↗
PubMed1982

Deformity of the proximal tibia in dogs.

A condition has been recognised in five young dogs in which the proximal tibia exhibited cranial bowing. This altered conformation, sometimes accompanied by bow legs (genu varum), occurs bilaterally, but to differing degrees. The deformity apparently altered the biomechanics of the stifle joint so that degenerative joint disease and rupture of the cranial cruciate ligament followed in four of the five dogs. The aetiology is unknown, but the most likely cause appears to be retardation of growth in the caudal aspect of the proximal tibial physis. Treatment involving surgical techniques to correct the joint instability was only moderately successful.

Animals↗
PubMedDate not supplied

Radiographic characteristics of lower-extremity bowing in children.

Lower-extremity bowing is common in infants and children and can result from a variety of conditions. At radiography, developmental bowing shows varus angulation centered at the knee, "metaphyseal beaking," thickening of the medial tibial cortices, and tilted ankle joints. Tibia vara (Blount disease) demonstrates genu varum and depression of the proximal tibia medially. Congenital bowing manifests as posteromedial bowing with cortical thickening along the concavity of the curvature and, in some cases, diaphyseal broadening. In rickets, radiographic changes occur primarily at sites of rapid growth and are predominantly metaphyseal, with widening of the zone of provisional calcification. Achondroplasia is characterized by shortening and thickening of the long bones with metaphyseal flaring and cupping. In neurofibromatosis, there may be anterolateral bowing of the tibia, and there is often focal narrowing and intramedullary sclerosis or cystic change at the apex of the angulation. The tibia is typically involved at the junction of the middle and distal thirds. Osteogenesis imperfecta demonstrates bowing from softening due to osteoporosis and multiple fractures and typically involves the entire skeleton. In camptomelic dysplasia, lower-extremity bowing is associated with a short trunk, short limbs, and deficiencies in pelvic bone development. Recognition of these pathologic conditions is important for differentiating those that will resolve spontaneously from those that require surgery or other treatment.

Abnormalities, Multiple↗
PubMedDate not supplied

Anatomical and physiologic characteristics to predict football ability. Report of study methods and correlations, University of Arkansas, 1976.

In a prospective study of 56 scholarship players at the University of Arkansas in 1976, 14 anatomical and physiologic measurements were carried out on each of the 56 players, to include certain orthopaedic strength, power, and balance tests, and compared to the coaches' subjective ratings of football ability in an effort to determine which characteristics best correlate to the athlete's true performance. The correlation matrix for the criterion measure and the predictor variables of selected anatomical strength, balance, and power measures are presented, and the results of the study indicate that genu varum (0.445) and tibial torsion (-0.33) had the highest correlation with the coaching criterion variable. The average tibial torsion was 42.6 for these scholarship athletes, while normal average tibial torsion among a nonscholarship group was 27.40 degrees. Other anatomical characteristics measured, as well as strength and power measure, could not reach the critical level of +/- 0.263 to be significant at the 0.05 level, although horsepower was close (0.255). The Margaria-Kalamen power test was significantly related to the 40-yard dash, and a moderately good measure of football ability.

Anthropometry↗
PubMed1983

Medial femoral condyle necrosis and chondrocalcinosis--a causal relationship?

The three cases of idiopathic medial femoral condyle necrosis, presenting to this hospital over a five-year period, are reported. All the patients also had chondrocalcinosis in the affected knee at the time of presentation, an association previously not recorded. Only one patient, however, showed evidence of generalised chondrocalcinosis. To date two knees have come to total knee replacement for aggressive degenerative disease in the medial compartment and genu varum. It is not certain whether chondrocalcinosis and medial femoral condyle necrosis are linked aetiologically; however, it would seem that the presence of chondrocalcinosis is an adverse prognostic indicator.

Aged↗