Knee Malalignment | Misalignment

What is knee malalignment?

Knee malalignment occurs when the femur (thigh bone), tibia (shin bone), or patella (kneecap) shift away from a straight line resulting in uneven weight distribution on the knee over a period of time. These bones, together with various other soft tissue structures, form an intricate joint system that relies heavily on even weight distribution. Uneven weight distribution can cause the knee to bow inward or outward, causing undue stress on a portion of the knee. Birth-related complications, genetics, a traumatic event, or the natural aging process can cause knee malalignment and lead to patellar dislocation or premature osteoarthritis. 

What is knee misalignment?

Knee Misalignment is usually a mild issue that has to do with alignment of the knee. Misalignment can occur if there is an acute injury to the knee, poor posture, or muscle imbalances. Misalignment might not indicate a permanent structural abnormality. Unlike malalignment, misalignment is more commonly used in everyday language and can often be corrected with physical therapy or adjustments in posture. Malalignment tends to be more serious and long-term.

What is valgus malalignment?

When the hip, knee, and ankle shift from a straight line causing a “knock-kneed” appearance is known as valgus malalignment. This inward shift of the knee joint results in the outer knee joint bearing more weight. The substantial increase in weight being exerted on the outer portion of the knee often leads to premature onset of osteoarthritis.

What is varus malalignment?

Varus malalignment occurs when the tibia shifts closer to the midline and is no longer in line with the femur. The resulting “bow-legged” appearance from the outward shift of the knee joint causes the inner portion of the knee joint to bear significantly more weight than the outer portion. Varus malalignment, similar to valgus malalignment, can precipitate early-onset osteoarthritis of the inner knee joint. Dr. Prem Ramkumar,  orthopedic knee specialist is located in Long Beach and serves patients in Los Angeles, Orange County, and surrounding Southern California areas who may be experiencing early onset arthritis from knee malalignment

What are the symptoms of knee malalignment?

Individuals with either valgus or varus knee malalignment often describe knee pain that is exacerbated with movement of the knee joint. Other symptoms include:

• Knee swelling and stiffness
• Unusual gait
• Knees bowing inward or outward
• Pain located underneath the kneecap
• A “clicking” sound when the knee is extended
• A feeling of the knee being generally unstable or “giving way”
• The knee “catching” or “locking” sensation with knee joint movement

How is knee malalignment diagnosed?

Dr. Ramkumar will assess the patient by first, gathering a detailed medical history with a focus on prior knee injuries, underlying health conditions, and the current symptoms. This is followed by a thorough physical examination where the degree of knee malalignment is measured. Diagnostic imaging studies, such as x-rays and magnetic resonance imaging (MRI), can be useful for identifying bone-related damage and signs of osteoarthritis as well as confirming the degree of knee malalignment.

What is the treatment for knee malalignment?

Non-surgical treatment:

Non-surgical therapies alone may be beneficial for patients with minimal knee malalignment and no other concomitant issues. These can include avoiding or limiting activities that may further damage the knee joint in conjunction with non-steroidal anti-inflammatory medications (NSAIDs) to alleviate any knee pain and inflammation. When appropriate, a physical therapy program involving strength training will be recommended to further minimize any unnecessary pressure off of the knee joint. Injections may be offered in certain situations that cause a joint to prematurely deteriorate and/or avoid surgical reconstruction.

Surgical treatment:

Surgical intervention is typically necessary when patients continue to experience persistent pain after a trial of conservative therapies. The mechanical correction of knee malalignment is accomplished through a  surgical procedure called an osteotomy. This is done by cutting the bone to realign or reposition the bone in a more mechanically favorable position. Sometimes this involves a wedge that is either removed entirely or transferred to a different location within the knee joint, depending on the degree of malalignment. Dr. Ramkumar will evaluate several patient factors, such as age, activity level, and medical history, to determine which osteotomy procedure will best address the patient’s needs. These may include:

• Distal Femoral Osteotomy. This technique corrects valgus malalignment by extracting a bone wedge from the distal (outside of the knee area) end of the femur closest to the knee joint. A bone graft material is introduced into the new opening and a metal plate is fastened to prevent closure.
• High Tibial Osteotomy. To address varus malalignment, a bone wedge is removed from the proximal end (inside area of the knee) at the tibia and closest to the knee joint. This new opening can be left open or closed by aligning plates and screws.