From the Guidelines
Genu valgum, or knock-knees, is a condition that can be managed with observation, physical therapy, and custom orthotics, with surgery reserved for severe cases. The condition is characterized by the knees angling inward and touching while the ankles remain separated, and it is normal in young children between ages 2-7 as part of development, typically resolving spontaneously by age 7-8 [ 1 ]. For persistent cases in children, observation is recommended with regular monitoring by a healthcare provider, and no specific medication is needed for developmental genu valgum. Some key points to consider in the management of genu valgum include:
- The use of medial wedge insoles for valgus knee OA, as conditionally recommended by the American College of Rheumatology [ 1 ]
- The importance of maintaining a healthy weight, as obesity can worsen the condition by placing additional stress on the knees [ 1 ]
- The consideration of physical therapy to strengthen supporting muscles, custom orthotics to improve alignment, night braces in growing children, or surgery in severe cases (osteotomy or guided growth procedures) [ 1 ] The most effective treatment approach will depend on the individual case, but a combination of non-pharmacological and pharmacological treatment modalities is often recommended [ 1 ]. Some key treatment options include:
- Non-pharmacological modalities such as aerobic, aquatic, and/or resistance exercises, as well as weight loss for overweight patients [ 1 ]
- Pharmacologic modalities such as acetaminophen, oral and topical NSAIDs, tramadol, and intraarticular corticosteroid injections [ 1 ]
- Surgery, which is typically reserved for angles exceeding 15 degrees, significant pain, or functional limitations [ 1 ]
From the Research
Definition and Treatment of Genu Valgum
- Genu valgum, also known as knock-knees, is a common disorder affecting adolescents and young adults, characterized by a valgus deformity of the knee joint 2.
- Treatment of genu valgum requires restoration of normal mechanical axis alignment and joint orientation, and various osteotomies of the distal femur have been described, including lateral opening wedge, medial closing wedge, dome, and spike osteotomies 2, 3, 4.
Surgical Techniques for Genu Valgum Correction
- A wedgeless V-shaped osteotomy of the distal medial femur with locking plate fixation is a safe and effective procedure for correcting genu valgum in adolescents and young adults 2.
- Medial closing wedge osteotomy is another technique used to correct genu valgum and torsional malalignment, and has been shown to improve clinical outcomes and reduce cartilage damage 3.
- Lateral opening wedge distal femoral osteotomy (LOWDFO) is a reliable procedure for reconstructing knee alignment in patients with genu valgum originating in the distal femur, and can be performed without bone grafting 4.
- Two-level osteotomy, including medial closing wedge osteotomy at the distal femur and translational osteotomy at the tibial shaft, can be used to correct genu valgum and tibia valga in a single stage 5.
Clinical Outcomes and Radiographic Results
- Studies have shown that osteotomy procedures for genu valgum correction can improve clinical outcomes, including KOOS scores, and radiographic results, including mechanical axis deviation and lateral distal femoral angle 2, 3, 4.
- A distal femoral varus producing osteotomy has been shown to reduce symptomatic patellofemoral instability and improve clinical outcomes in patients with recurrent traumatic patellar instability and genu valgum 6.