Etiology of internal and external knee valgus
Pathogenesis of internal derangement of the knee
1, Calcium deficiency and heredity are the two bases for the formation of internal knee valgus.
2, but more directly or in walking, standing, sitting and some sports factors, long time to the knee side of the force, and this force will pull the knee side of the lateral collateral ligament, long-term, resulting in unilateral collateral ligament relaxation.
3. The medial and lateral collateral ligaments of the knee are the stabilizing structures of the medial and lateral angles of the knee. When the lateral collateral ligament is lax, the medial collateral ligament will pull the tibia of the lower leg to rotate medially, forming an inversion of the knee, and the opposite will form an eversion of the knee.
The harm of internal and external knee rollover
1. Affects body shape and aesthetics.
2. Damage to health – secondary to osteoarthritis.
3. The psychological stress caused by the harm to body shape and health.
Clinical manifestations
1.Knee discomfort
Children or adolescent patients, with a short disease duration, have mild or no knee symptoms. With the growth of age, adolescent patients pay more attention to the deformity, the psychological burden gradually increases, the knee may appear mild discomfort, but the psychological pressure is greater than the knee discomfort. 30 years of age or older patients have more obvious symptoms, generally after walking or exertion, the knee is sore and uncomfortable or painful, if the deformity is serious, it can be accompanied by ankle discomfort, the symptoms can be relieved after rest, middle-aged and older patients appear secondary knee The clinical manifestations of osteoarthritis of the knee joint.
2, knee pain and limited activity early pain is less obvious, generally after 25 to 30 years of illness, began to appear knee pain symptoms, the beginning only after walking a long distance, the knee pain, rest can be self-relieved. Later, the symptoms gradually worsen and the pain is persistent, affecting sleep and rest. Following the increase in pain, the knee joint flexion and extension activities are also limited to varying degrees, and the range of flexion may become smaller and smaller, with some having only a few dozen degrees of range of motion, and in severe cases, the knee joint tends to become stiff.
3. Deformity
The most typical and prominent signs of internal and external knee valgus. In cases of internal knee, the knee joint bulges outward, the inner edges of both knees cannot be brought together, the distance between the knee condyles increases, and the frontal view of both lower extremities is “O” shaped, or “D” shaped if one knee is internally turned. In the case of knee valgus, the lower legs are abducted, and when the lower limbs are standing, the knees are together and the ankles cannot touch, leaving an “X” shaped leg, and in the case of single limb valgus, it is “K” shaped.
4.Tibial rotation
In normal adults, the tibia is gradually rotated distally from the tibial tuberosity to the ankle, with an average of 16.26° of left-sided external rotation and 16.42° of right-sided external rotation in men, and 21.48° of left-sided external rotation and 22.26° of right-sided external rotation in women. In patients with internal knee valgus, the tibia is internally rotated to varying degrees, more than 50° in severe cases, and internal rotation of the tibia can also occur in patients with external knee valgus.
5. Gait
In patients with internal derangement of the knee, the lower limbs are unstable and sway from side to side when walking, which can occur in young children and gradually worsen; in patients with mild knee valgus, the gait is not significantly abnormal, while in patients with severe knee valgus, the knee joint is flexed when walking, the stride length is small, the frequency is large and the gait is swaying from side to side. In supine position, knee inversion: inner ankles together, measure the distance between the two femoral inner condyles; knee ectropion: two femoral inner condyles together, measure the inner ankle distance; in standing position, feet together, gravity line from the anterior superior iliac spine down through the center of the patella, passing between the 1st and 2nd metatarsals when normal, and biased laterally in knee inversion and medially in knee ectropion.
Treatment
1. Non-surgical treatment: Suitable for early stage of deformity and mild symptoms, methods include splinting, leg binding, exercise, orthopedic apparatus, shoe inserts, etc. The advantages are low cost and low risk, but the defects are active treatment, slow effect, long treatment period, easy to leave joint deformity, and poor treatment effect for those with severe deformity.
2.Surgical treatment.
(1) plate intramedullary needle: one-time correction, more damage, more side effects; common complications: peroneal nerve injury, vascular embolism, osteofascial compartment syndrome.
(2) joint replacement: large damage, high cost of treatment, short life span, only for older patients, often requires revision.
(3) tibial osteotomy + external fixator gradual orthopedic: relatively simple operation, less injury, conducive to recovery, facilitate postoperative adjustment of force line, angle, easy to observe changes in the condition gradually orthopedic, deformity correction is complete.