Knee valgus is one of the more common deformities of the lower extremities, and deformity changes in the angles of the knee joint caused by various pathologies can lead to knee valgus deformity. The change in the weight bearing status and force line of the lower extremity and the abnormal walking gait of the patient will inevitably cause an increase in the load on the lateral side of the knee joint, which in turn leads to damage to the articular cartilage and degenerative changes in the knee joint. Ultimately, this leads to joint stiffness and walking dysfunction, seriously reducing the patient’s quality of life. Therefore, timely diagnosis and treatment of internal and external knee valgus is important to maintain the walking function and improve the quality of life of patients.
During normal human development, fetuses and newborns tend to show mild to moderate knee valgus, which is related to the fetal posture in the mother’s body, and this condition will gradually correct with growth and development. The transition to a relatively “mature” anatomic line of force continues for about 2 years, reaching a normal state around age 6. Patients older than 2 years of age who develop valgus should be actively sought for causative factors.
There are many diseases that can cause internal and external knee valgus, mainly in the following areas: 1. endocrine and metabolic diseases, such diseases are represented by rickets. 2.
2, diseases that directly cause the destruction of bone and joint, mainly including trauma, inflammation, tumors of the lower limbs, etc. Diseases that directly cause the destruction of bones, causing deformed bone changes, or destruction of the epiphyseal plate, resulting in asymmetric bone growth, leading to the occurrence of knee inversion.
3, diseases affecting cartilage and connective tissue development, such as osteogenesis imperfecta, multiple epiphyseal dysplasia, etc. Such diseases are mostly hereditary, and the causative genes lead to disorders of collagen, cartilage and other connective tissue formation, affecting bone formation or development, and eventually manifesting as abnormal bone growth and morphology.
4, neuromuscular lesions, polio sequelae, cerebral palsy sequelae, neuromuscular injury, etc., the disease causes spasm of the inward turning muscle group or relaxation of the outward turning muscle group, resulting in abnormal skeletal force, the long-term existence of unbalanced muscle force, resulting in the abnormal development of bone.
5, degenerative osteoarthritis, osteoarthritis, is a degenerative changes and damage to the articular cartilage, gradually leading to damage and proliferation of bone on both sides of the joint, the joint space also changes, and eventually cause changes in the entire lower limb upright line, resulting in knee inversion. At the same time, the formation of internal and external knee valgus will further accelerate the progression of osteoarthritis.
The clinical manifestation of the disease is typical, and is characterized by abnormalities in the appearance or walking gait of the lower extremities. Patients may walk with an “O” or “X” shaped lower extremity.
Because of the multiple causes of internal and external knee valgus, the treatment plan should be designed in a holistic manner, based on a comprehensive consideration of the patient’s age, predisposing factors, soft tissue and joint conditions, and the degree of deformity, and should be individualized.
First of all, primary diseases should be actively corrected: active endocrine and metabolic diseases should be corrected as soon as possible, the nutrition and metabolism of bone should be improved, the physiological development of bone should be promoted, and the strength of bone and the ability to resist external stress should be enhanced. The inversion of the knee is bound to recur after treatment, resulting in failure of treatment.
Generally speaking, children aged 2 to 4 years old with a tendency to self-correct internal and external knee valgus can be treated conservatively with regular review and observation of changes in the condition.
For patients over 4 years of age but with unclosed epiphyses, there is little possibility of self-correction of knee valgus deformity and surgical intervention should be considered, with the ultimate goal of surgery being to restore normal negative gravity lines to the lower extremity. Selective hemiepiphyseal block is currently a popular and safe and effective treatment option for children with internal and external knee valgus.
In patients with severe osteoarthritis, especially in the elderly, joint replacement is the mainstay of treatment.
For the majority of patients, osteotomy is one of the most effective means of restoring strength to the affected limb.
The biggest disadvantage of traditional osteotomy orthopedic surgery is that the correction of the deformity is entrusted to a single operation, and it is difficult to precisely control the position and angle of the osteotomy during the operation, which can easily lead to incomplete correction and overcorrection of the deformity, and often cause the recurrence of the deformity or the appearance of new deformity after the operation.
The use of adjustable external fixator (Ilizarov technique) has solved this problem well. The advantage of external fixation over internal fixation is the postoperative adjustability of the correction direction and angle, the gradual correction of the deformity by slow and continuous postoperative pulling, and the early weight-bearing to promote the healing of the osteotomy. However, when placing the external fixator, the center of the hinge should be aligned with the position of the osteotomy. In cases with osteoarthritis, the knee joint can be stretched by fixation across the joint to achieve better results.