1.

Deformities in knee
A. In children –
a. Bow leg & Knock knee
i. Physiological bow legs and knock knees
ii. Compensatory deformities
iii. Pathological bow leg and knock knee
iv. Blount’s disease
B. In Adult -
a. Genu varum & valgum
i. Sequel to childhood deformity
ii. Secondary to arthritis
iii. Ligament injuries,
iv. Malunited fractures and
v. Paget’s disease.
b. Genu recurvatum
i. Congenital recurvatum
ii. Lax ligaments
iii. Growth plate injuries and
iv. Malunited fractures

2. Lesions in the meniscus

A. Tear of meniscus
B. Meniscal degeneration
C. Discoid lateral meniscus
D. Meniscal cyst

3. Ligamentus instability
A. Acute instability
B. Chronic instability

4. Recurrent dislocation of patella

5. Patellofemoral pain syndrome
6. Osteochondritis dessicans
7. Loose body
8. Plica syndrome
9. Synovial chondrometosis
10. TB
11. RA
12. OA
13. Osteonecrosis
14. Charcot disease
15. Haemophilic arthritis
16. Rupture of the extensor apparatus
17. Tendinitis around the knee

18. Knee swelling

A. Entire joint
 a. Acute swelling
i. Posttraumatic haemarthrosis
ii. Bleeding disorder
iii. Septic Arthritis
iv. Traumatic synovitis
v. Aseptic non traumatic synovitis
b. Chronic swelling
i. Arthritis
ii. Synovial disorder
B. Part of joint
a. In front of joint
i. Prepatellar bursitis (Housemaids knee)
ii. Infrapatellar bursitis (Clergyman’s knee)
iii. Other bursa
b. Back of knee
i. Semimembranosus bursa
ii. Popliteal cyst
iii. Popliteal anurysm
c. Bony swelling around the knee

Causes of Genu valgum and varum and recurvatum

Causes Genu varum Genu valgum
Common
Idiopathic Babies < 4 years Babies > 4 years
(physiological age)
Pathological
Congenital Skeletal dysplasia Congenital dislocation
a. Metaphyseal of patella
 b. Achondroplasia Skeletal dysplasia
Developmental Blount’s disease (tibial
vara)
Compensatory Persistent antiversion
of femoral neck
Metabolic a. Nutritional a. Nutritional
rickets rickets
b. Vit D resistant b. Vit D resistant
rickets rickets
c. Renal c. Renal
osteodystrophy osteodystrophy
Infection Physeal damage by Physeal damage by
a. TB a. TB
b. Osteomyelitis b. Osteomyelitis
Tumor Physeal Physeal
involvement involvement
Traumatic a. Physeal injury a. Physeal injury
b. Ligamentous b. Ligamentous
injury injury
c. Following # of c. Following # of
proximal tibial proximal tibial
metaphysic metaphysic
d. Malunion d. Malunion
Adult a. Squeal of a. Squeal of
childhood childhood
deformity deformity
b. Primary OA b. RA
c. Ligamentous c. Ligamentous
injury injury
d. Malunion d. Malunion
e. Paget’s disease e. Paget’s disease

Causes of genu recurvatum

A. Abnormal intrauterine posture
B. Lax ligament - generalized joint laxity tend In paralytic conditions
(e.g. poliomyelitis)
a. Prolonged traction (especially on a frame) recurvatum associated
b. knee hyperextended in plaster (overstretch ligaments)
with fixed equines of
the ankle: in order to
c. following chronic or recurrent synovitis (especially
set thein RA)
foot flat on the
d. hypotonia of rickets ground, the knee is
forced into
e. flailness of poliomyelitis hyperextension.
f. Charcot’s disease. (due to insensitivity) - In moderate degrees,
this may actually be
C. Others helpful (e.g. in
a. Growth plate injury stabilizing a knee with
weak extensors).
b. Malunited fracture - If excessive &
prolonged, it may give

Management plan
A. Genu Varum
i. Conservative
 Indication
 o Mild varus deformity(10 - 15°)
o Young childhood <3 years
 KAFO
o Produces valgus forces
o Applied for 23 hours /day
o Follow up every 3 monthly
ii. Operative
 Indication
o Failure of 1 year trial with KAFO
o Child presenting even after 3 years
o Severe deformity
 Option
Lateral closed
wedge
(Proximal to 1.
adductor tubercle)
Supracondylar valgus osteotomy Medial
> open wedge
14
year
Lateral epiphyseal stappling
4 – 14
s Lateral haemiepiphysiodesis
Lateral closed
Commonly done wedge
2. High tibial valgus osteotomy Medial
open wedge
+ Diaphyseal fibular osteotomy
B. Genu Valgum
i. Conservative
 Indication
o Mild valgus deformity (intramalleolar distance
< 10 cm)
i. 0-4 yr – only stretching
ii. 4-10 yr - brace
 Reassurance
 Raised medial heel (3/16 inch)
 Knock knee brace
ii. Operative
 Indication
o Persistant physiological genu valgum
o Severe deformity (intramalleolar
distance > 10 cm)
 Option
Medial closed wedge
Commonly done1. Supracondylar valgus osteotomy Lateral
open wedge
Medial epiphyseal stappling
Medial haemiepiphysiodesis
Medial closed wedge
2. High tibial valgus osteotomy Lateral
open wedge
+ Diaphyseal fibular osteotomy
 C. Genu recurvatum
Conservative – KAFO
Operative –
1. Corrective(to osteotomy
preserve the –
o knee should be left with some
stabilizing
mechanism)
hyperextension
o With caliper - If quadriceps power is
poor
2. Fixing the patella into the
tibial plateau as a bone block
o In Severe paralytic hyperextension

Timing of operation
After growth spurt
Girl > 11 years
Boy > 12 years