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Review
. 2022 May 18;13(5):427-443.
doi: 10.5312/wjo.v13.i5.427.

Coronal plane deformity around the knee in the skeletally immature population: A review of principles of evaluation and treatment

Valentino Coppa  1 , Mario Marinelli  1 , Roberto Procaccini  1 , Danya Falcioni  1 , Luca Farinelli  1 , Antonio Gigante  2
Affiliations
Review

Coronal plane deformity around the knee in the skeletally immature population: A review of principles of evaluation and treatment

Valentino Coppa et al. World J Orthop. .

Abstract

Coronal plane deformity around the knee, also known as genu varum or genu valgum, is a common finding in clinical practice for pediatricians and orthopedists. These deformities can be physiological or pathological. If untreated, pathological deformities can lead to abnormal joint loading and a consequent risk of premature osteoarthritis. The aim of this review is to provide a framework for the diagnosis and management of genu varum and genu valgum in skeletally immature patients.

Keywords: Genu valgum; Genu varum; Guided growth; Knee deformity; Lower limb deformity; Osteotomy; Pediatric deformity.

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Conflict of interest statement

Conflict-of-interest statement: Authors declare they have not conflict of interests.

Figures

Figure 1
Figure 1
Lower limb axes evaluated in long standing X-ray. FTMA: Femorotibial mechanical axis; MAF: Mechanical axis of the femur; AAF: Anatomical axis of the femur; MAT: Mechanical axis of the tibia; AAT: Anatomical axis of the tibia.
Figure 2
Figure 2
The malalignment test. The mechanical axis (MA) is traced from the center of the femoral head to the center of the ankle. The metaphyseal-diaphyseal angle (MAD) is calculated in millimeters (dotted lines in the image traced from center of knee and MA). If the MAD exceeds the threshold of normality, it is necessary to find the source of the deformity. The mechanical lateral distal femur angle. Medial proximal tibial angle are evaluated. A: Varus; B: Normal; C: Valgus. MAD: Metaphyseal-diaphyseal angle; MPTA: Medial proximal tibial angle; mLDFA: Mechanical lateral distal femur angle.
Figure 3
Figure 3
Staple hemiepiphysiodesis.
Figure 4
Figure 4
Tension band plate hemiepiphysiodesis for correcting genu valgum deformity.
Figure 5
Figure 5
Radiographic measurement of Drennan’s metaphyseal-diaphyseal angle. The metaphyseal-diaphyseal angle (MDA) is measured from a perpendicular line to the tibial diaphyseal axis and a line passing through the axial plane of the proximal tibial metaphysis. An MDA > 10 degrees associated with a tibiofemoral angle > 20 degrees indicates a toddler at risk. MDA: Metaphyseal-diaphyseal angle.
Figure 6
Figure 6
High tibial osteotomy for genu varum correction.
See this image and copyright information in PMC

References

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