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Knee

Knee Malalignment

What is knee malalignment?

Knee malalignment occurs when the bones of the leg are not properly aligned, causing uneven pressure across the joint. This can lead to pain, cartilage wear, and early arthritis, especially in the overloaded part of the knee.

Varus malalignment, or “bow-leggedness,” occurs when the knees angle outward and more weight is placed on the inner (medial) part of the knee. It often leads to medial compartment arthritis.

Valgus malalignment, or “knock-knees,” happens when the knees angle inward, putting extra stress on the outer (lateral) part of the knee. Over time, this can cause lateral joint pain and cartilage damage.

Diagnosis begins with a physical exam and detailed imaging. Standing full-length leg X-rays (alignment films) are used to assess the angles of the hip, knee, and ankle to determine where the imbalance lies.

Treatment is considered when malalignment causes pain, limits activity, or contributes to cartilage damage or early arthritis. If symptoms don’t improve with physical therapy or bracing, surgery may be recommended to offload the affected part of the knee.

An osteotomy is a surgical procedure that involves cutting and realigning the bone to shift weight away from the damaged part of the knee. It can help delay or prevent the need for a knee replacement in younger, active patients.

A high tibial osteotomy (HTO) is performed to correct varus malalignment. The upper shin bone (tibia) is cut and reshaped to shift pressure from the inner to the outer part of the knee, relieving pain and improving alignment.

A distal femoral osteotomy (DFO) is used to correct valgus malalignment. The lower end of the thigh bone (femur) is realigned to move load-bearing forces away from the lateral compartment of the knee.

Recovery from osteotomy typically takes at least 6 months. Patients may need crutches and a brace early on. Physical therapy helps restore motion, strength, and balance. Full return to impact activities may take 6 to 9 months depending on bone healing and progress.

At a Glance

Sachin Allahabadi, MD

  • Board-Certified & Fellowship-Trained Sports Medicine Surgeon
  • Expertise in Minimally Invasive Knee & Shoulder Surgeries
  • Assistant Professor of Clinical Orthopaedic Surgery, Houston Methodist Hospital & Weill Cornell Medical College
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