Coppa V, Marinelli M, Procaccini R, Falcioni D, Farinelli L, Gigante A. Coronal plane deformity around the knee in the skeletally immature population: A review of principles of evaluation and treatment. World J Orthop 2022; 13(5): 427-443 [PMID: 35633744 DOI: 10.5312/wjo.v13.i5.427]
Corresponding Author of This Article
Antonio Gigante, MD, Full Professor, Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Via Tronto 10/A, Ancona 60121, Italy. scienza.clinortop@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. May 18, 2022; 13(5): 427-443 Published online May 18, 2022. 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, Mario Marinelli, Roberto Procaccini, Danya Falcioni, Luca Farinelli, Antonio Gigante
Valentino Coppa, Mario Marinelli, Roberto Procaccini, Danya Falcioni, Luca Farinelli, Antonio Gigante, Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona 60121, Italy
Author contributions: Coppa V and Gigante A wrote the paper; Marinelli M, Procaccini R, Falcioni D and Farinelli L collected the data.
Conflict-of-interest statement: Authors declare they have not conflict of interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Antonio Gigante, MD, Full Professor, Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Via Tronto 10/A, Ancona 60121, Italy. scienza.clinortop@gmail.com
Received: February 25, 2021 Peer-review started: February 25, 2021 First decision: July 28, 2021 Revised: October 2, 2021 Accepted: April 8, 2022 Article in press: April 8, 2022 Published online: May 18, 2022
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.
Core Tip: Physiological angulation requires no treatment other than clinical observation. If the clinical picture is doubtful, a long-standing X-ray of the lower limb is required for clarification. Once a pathological alignment is determined by X-ray, a differential diagnosis is needed to establish whether the deformity is idiopathic or a secondary condition. Furthermore, any associated deformities in other planes (e.g., rotation or length difference) should be evaluated. Pathological alignment should be treated for at least two reasons: To interrupt the vicious circle described by the Hueter-Volkmann law and to prevent premature degeneration of the joint. Both of these conditions stem from abnormal load distribution. Guided growth should be considered every time a coronal deformity of the knee is foreseen in a skeletally immature patient. Although comparative studies are lacking in the literature, this technique has a high success rate with few complications and a low impact on the patient and the family.
