Lower Extremity Alignment: Genu Varum / Valgum
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- Donna Lindsey
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1 Lower Extremity Alignment: Genu Varum / Valgum Arthur B Meyers, MD Nemours Children s Hospital & Health System Associate Professor of Radiology, University of Central Florida Clinical Associate Professor of Pediatric Radiology, Florida State University
2 Disclosures Author/editor for Amirsys/Elsevier, receiving royalties
3 Outline Definitions Normal knee alignment during development Genu Varum Genu Valgum
4 Outline Definitions Normal knee alignment during development Genu Varum Genu Valgum
5 Varus Valgus
6 Varus Distal to angulation Valgus Distal to angulation
7 Varus Distal to angulation Apex of angulation Valgus Distal to angulation Apex of angulation
8 Varus Distal to angulation Apex of angulation Valgus Distal to angulation Apex of angulation Midline Right Left
9 Varus Distal to angulation Apex of angulation Valgus Distal to angulation Apex of angulation Midline Right Left
10 Varus Distal to angulation deviates to midline Apex of angulation Valgus Distal to angulation Apex of angulation Midline Right Left
11 Varus Distal to angulation deviates to midline Apex of angulation points from midline Valgus Distal to angulation Apex of angulation Midline Right Left
12 Varus Distal to angulation deviates to midline Apex of angulation points from midline Valgus Distal to angulation Apex of angulation Midline Right Left
13 Varus Distal to angulation deviates to midline Apex of angulation points from midline Valgus Distal to angulation Apex of angulation Midline Right Left
14 Varus Distal to angulation deviates to midline Apex of angulation points from midline Valgus Distal to angulation deviates from midline Apex of angulation Midline Right Left
15 Varus Distal to angulation deviates to midline Apex of angulation points from midline Valgus Distal to angulation deviates from midline Apex of angulation points to midline Midline Right Left
16 Normal Knee Alignment
17 Tibiofemoral angle
18 Tibiofemoral angle On standing radiograph
19 Tibiofemoral angle On standing radiograph Angle between lines parallel to: Mid femoral diaphysis Mid tibial diaphysis
20 Tibiofemoral angle Salenius P, et al. Development of the tibiofemoral angle in children. J Bone Joint Surg Am Mar;57(2):
21 Tibiofemoral angle 0-1 yr varus Salenius P, et al. Development of the tibiofemoral angle in children. J Bone Joint Surg Am Mar;57(2):
22 Tibiofemoral angle 0-1 yr varus 1-2 yrs 0-10 varus Salenius P, et al. Development of the tibiofemoral angle in children. J Bone Joint Surg Am Mar;57(2):
23 Tibiofemoral angle 0-1 yr varus 1-2 yrs 0-10 varus 2-3 yrs 0-10 valgus Salenius P, et al. Development of the tibiofemoral angle in children. J Bone Joint Surg Am Mar;57(2):
24 Tibiofemoral angle 0-1 yr varus 1-2 yrs 0-10 varus 2-3 yrs 0-10 valgus 3-4 yrs 8-12 valgus Salenius P, et al. Development of the tibiofemoral angle in children. J Bone Joint Surg Am Mar;57(2):
25 Tibiofemoral angle 0-1 yr varus 1-2 yrs 0-10 varus 2-3 yrs 0-10 valgus 3-4 yrs 8-12 valgus 4-13 yrs ~6 valgus Salenius P, et al. Development of the tibiofemoral angle in children. J Bone Joint Surg Am Mar;57(2):
26 Developmental changes 1-year-old 3-year-old 13-year-old
27 Developmental changes 1-year-old 3-year-old 13-year-old Varus
28 Developmental changes 1-year-old 3-year-old 13-year-old Varus Valgus
29 Developmental changes 1-year-old 3-year-old 13-year-old Varus Valgus Mild Valgus
30 Genu varum
31 Genu varum / Bowing Angular deformity at the knee Apex of the deformity points away from the midline. Leg (below knee) deviates toward the midline. Common referral to orthopedic clinics Up-to-date, 2017
32 Genu varum / Bowing Angular deformity at the knee Apex of the deformity points away from the midline. Leg (below knee) deviates toward the midline. Common referral to orthopedic clinics Up-to-date, 2017
33 Genu varum / Bowing Differential diagnosis: Exaggerated physiologic bowing Blount disease Abnormal bones Metabolic bone disease Skeletal dysplasias Physeal/metaphyseal injury Up-to-date, 2017
34 Genu varum / Bowing Differential diagnosis: Exaggerated physiologic bowing Blount disease Abnormal bones Metabolic bone disease Skeletal dysplasias Physeal/metaphyseal injury Up-to-date, 2017
35 Exaggerated Physiologic Bowing
36 Exaggerated Physiologic Bowing Exaggeration of the normal age-related bowing Birth 2yrs Bilateral & symmetric Normal stature <2 sd of mean height for age & sex
37 Exaggerated Physiologic Bowing Radiographs 23-month-old
38 Exaggerated Physiologic Bowing Radiographs Varus angulation 20 varus 1-2 years nl = 0-10 varus 23-month-old
39 Exaggerated Physiologic Bowing Radiographs Varus angulation Medial tibial metaphysis Mild enlargement / depression Mild beaking No fragmentation 23-month-old
40 Exaggerated Physiologic Bowing Radiographs Varus angulation Medial tibial metaphysis Mild enlargement / depression Mild beaking No fragmentation
41 Exaggerated Physiologic Bowing Radiographs Varus angulation Medial tibial metaphysis Mild enlargement / depression Mild beaking No fragmentation Mild thickening of the medial tibal cortex
42 Exaggerated Physiologic Bowing Radiographs Varus angulation Medial tibial metaphysis Mild enlargement / depression Mild beaking No fragmentation Mild thickening of the medial tibal cortex Normal metaphysealdiaphyseal angle
43 Metaphyseal Diaphyseal Angle MDA the angle between:
44 Metaphyseal Diaphyseal Angle MDA the angle between: Line drawn along the proximal tibial metaphysis
45 Metaphyseal Diaphyseal Angle MDA the angle between: Line drawn along the proximal tibial metaphysis Line perpendicular to the long axis of the tibia 10
46 Metaphyseal Diaphyseal Angle MDA the angle between: Line drawn along the proximal tibial metaphysis Line perpendicular to the long axis of the tibia MDA values Physiologic bowing MDA typically < 11 Blount disease MDA typically > 11 Borderline
47 Exaggerated Physiologic Bowing Initial 7 months later
48 Blount Disease
49 Blount Disease (Tibia Vara) Developmental disorder with disrupted endochondral ossification of the medial proximal tibial physis Abnormal development of the proximal, medial tibial epiphysis/metaphysis
50 Blount Disease (Tibia Vara) Developmental disorder with disrupted endochondral ossification of the medial proximal tibial physis Abnormal development of the proximal, medial tibial epiphysis/metaphysis Angular deformites: Genu varum Procurvatum Internal rotation of the tibia
51 Blount Disease (Tibia Vara) Developmental disorder with disrupted endochondral ossification of the medial proximal tibial physis Abnormal development of the proximal, medial tibial epiphysis/metaphysis Angular deformites: Genu varum Procurvatum Internal rotation of the tibia Limb shortening Leg length discrepancy if asymmetric or unilateral
52 Blount Disease Risk factors: Early ambulation Obesity African or Scandinavian descent
53 Blount Disease Risk factors: Early ambulation Obesity African or Scandinavian descent Etiology: unknown (likely multifactorial) Risk factors of early ambulation & obesity suggest biomechanical component
54 Blount Disease Risk factors: Early ambulation Obesity African or Scandinavian descent Etiology: unknown (likely multifactorial) Risk factors of early ambulation & obesity suggest biomechanical component Two forms: Infantile or early onset < 4 years Late onset >4 yrs Juvenile 4-10 yrs Adolescent >10 yrs
55 Langenskiöld Classification of Early Onset Blount Disease Sabharwal S. Blount Disease. J Bone Joint Surg Am, 2009 Jul 01; 91 (7):
56 Radiographic findings
57 Radiographic findings Standing AP radiograph
58 Radiographic findings Standing AP radiograph Genu Varum 15-month-old
59 Radiographic findings Standing AP radiograph Genu Varum Tibiofemoral angles ~ years nl = 0-10 varus 15-month-old
60 Radiographic findings Genu Varum (Standing AP radiograph) Increased metaphysealdiaphyseal angle (MDA) Physiologic bowing MDA typically < 11 Blount disease MDA typically > 11 Borderline
61 Radiographic findings Genu Varum (Standing AP radiograph) Increased metaphysealdiaphyseal angle (MDA) Physiologic bowing MDA typically < 11 Blount disease MDA typically > 11 Borderline
62 Radiographic findings Genu Varum (Standing AP radiograph) Increased metaphyseal-diaphyseal angle (MDA) 1 year later
63 Radiographic findings Genu Varum (Standing AP radiograph) Increased metaphyseal-diaphyseal angle (MDA) Widened medial tibial physis Medial tibial metaphysis Depression Beaked Irregular / fragmented
64 Radiographic findings Genu Varum (Standing AP radiograph) Increased metaphyseal-diaphyseal angle (MDA) Widened medial tibial physis Medial tibial metaphysis Depression Beaked Irregular / fragmented
65 Radiographic findings Genu Varum (Standing AP radiograph) Increased metaphyseal-diaphyseal angle (MDA) Widened medial tibial physis Medial tibial metaphysis Depression Beaked Irregular / fragmented
66 Radiographic findings Genu Varum (Standing AP radiograph) Increased metaphyseal-diaphyseal angle (MDA) Widened medial tibial physis Medial tibial metaphysis Depression Beaked Irregular / fragmented
67 Radiographic findings Genu Varum (Standing AP radiograph) Increased metaphyseal-diaphyseal angle (MDA) Widened medial tibial physis Medial tibial metaphysis Depression Beaked Irregular / fragmented
68 Radiographic findings Genu Varum (Standing AP radiograph) Increased metaphyseal-diaphyseal angle (MDA) Widened medial tibial physis Medial tibial metaphysis Depression Beaked Irregular / fragmented
69 Radiographic findings Genu Varum (Standing AP radiograph) Increased metaphyseal-diaphyseal angle (MDA) Widened medial tibial physis Medial tibial metaphysis Depression Beaked Irregular / fragmented Medial tibial epiphysis Abnormal/delayed ossification
70 Radiographic findings Angular deformities: Genu varum Lateral subluxation of the tibia Procurvatum
71 Radiographic findings Angular deformities: Genu varum Lateral subluxation of the tibia Procurvatum
72 Radiographic findings Angular deformities: Genu varum Lateral subluxation of the tibia Procurvatum Lateral radiograph 10 year old
73 Radiographic findings Angular deformities: Genu varum Lateral subluxation of the tibia Procurvatum Lateral radiograph
74 Radiographic findings Angular deformities: Genu varum Lateral subluxation of the tibia Procurvatum Lateral radiograph
75 MRI Findings
76 MRI Findings Medial Proximal Tibia
77 MRI Findings Medial Proximal Tibia Physis / metaphysis Physeal widening
78 MRI Findings Medial Proximal Tibia Physis / metaphysis Physeal widening Downsloping / irregularity
79 MRI Findings Medial Proximal Tibia Physis / metaphysis Physeal widening Downsloping / irregularity
80 MRI Findings Medial Proximal Tibia Physis / metaphysis Physeal widening Downsloping / irregularity Physeal Bridge
81 MRI Findings Medial Proximal Tibia Physis / metaphysis Physeal widening Downsloping / irregularity Physeal Bridge
82 MRI Findings Medial Proximal Tibia Physis / metaphysis Physeal widening Downsloping / irregularity Physeal Bridge Epiphyseal cartilage Far medial thick Central medial - thin Increased joint space
83 MRI Findings Medial Proximal Tibia Physis / metaphysis Physeal widening Downsloping / irregularity Physeal Bridge Epiphyseal cartilage Far medial thick Central medial - thin Increased joint space
84 MRI Findings Medial Proximal Tibia Physis / metaphysis Physeal widening Downsloping / irregularity Physeal Bridge Epiphyseal cartilage Far medial thick Central medial - thin Increased joint space Ho-Fung V, et al. Pediatr Radiol (2013)
85 MRI Findings Medial Proximal Tibia Physis / metaphysis Physeal widening Downsloping / irregularity Physeal Bridge Epiphyseal cartilage Far medial thick Central medial - thin Increased joint space Ho-Fung V, et al. Pediatr Radiol (2013)
86 MRI Findings Medial Proximal Tibia Physis / metaphysis Physeal widening Downsloping / irregularity Physeal Bridge Epiphyseal cartilage Far medial thick Central medial - thin Increased joint space Medial Meniscus Thickened +/- abnormal signal
87 MRI Findings Medial Proximal Tibia Physis / metaphysis Physeal widening Downsloping / irregularity Physeal Bridge Epiphyseal cartilage Far medial thick Central medial - thin Increased joint space Medial Meniscus Thickened +/- abnormal signal
88 MRI Findings Medial Proximal Tibia Physis / metaphysis Physeal widening Downsloping / irregularity Physeal Bridge Epiphyseal cartilage Far medial thick Central medial - thin Increased joint space Medial Meniscus Thickened +/- abnormal signal
89 MRI Findings Medial Proximal Tibia Physis / metaphysis Physeal widening Downsloping / irregularity Physeal Bridge Epiphyseal cartilage Far medial thick Central medial - thin Increased joint space Medial Meniscus Thickened +/- abnormal signal Angular deformities Medial and posterior downsloping
90 MRI Findings Other findings:
91 MRI Findings Other findings: Lateral proximal tibia Physis - widened/irregular Metaphysis
92 MRI Findings Other findings: Lateral proximal tibia Physis - widened/irregular Metaphysis
93 MRI Findings Other findings: Lateral proximal tibia Physis Metaphysis - irregular
94 MRI Findings Other findings: Lateral proximal tibia Physis Metaphysis Femur Epiphysis Metaphysis Physis
95 MRI Findings Other findings: Lateral proximal tibia Physis Metaphysis Femur Epiphysis Metaphysis Physis Ho-Fung V, et al. Pediatr Radiol (2013)
96 MRI Findings Other findings: Lateral proximal tibia Physis Metaphysis Femur Epiphysis Metaphysis Physis Ho-Fung V, et al. Pediatr Radiol (2013)
97 MRI Findings Other findings: Lateral proximal tibia Physis Metaphysis Femur Epiphysis Metaphysis Physis Soft tissues Perichondral menbrane Thickened ACL - laxity Ho-Fung V, et al. Pediatr Radiol (2013)
98 Treatment of Blount Disease
99 Treatment Conservative Observation Orthosis
100 Treatment Conservative Observation Orthosis Surgery Lateral hemiepiphyseodesis Resection of a physeal bar Realignment osteotomy
101 Treatment Conservative Observation Orthosis Surgery Lateral hemiepiphyseodesis Resection of a physeal bar Realignment osteotomy
102 Treatment Conservative Observation Orthosis Surgery Lateral hemiepiphyseodesis Resection of a physeal bar Realignment osteotomy
103 Treatment Conservative Observation Orthosis Surgery Lateral hemiepiphyseodesis Resection of a physeal bar Realignment osteotomy
104 Genu varum / Bowing Differential diagnosis: Exaggerated physiologic Blount disease Abnormal bones Metabolic bone disease Skeletal dysplasias Physeal/metaphyseal injury
105 Genu varum / Bowing Differential diagnosis: Exaggerated physiologic Blount disease Abnormal bones Metabolic bone disease Skeletal dysplasias Physeal/metaphyseal injury
106 Genu varum / Bowing Differential diagnosis: Exaggerated physiologic Blount disease Abnormal bones Metabolic bone disease Rickets Skeletal dysplasias Physeal/metaphyseal injury 3-year-old girl with rickets
107 Genu varum / Bowing Differential diagnosis: Exaggerated physiologic Blount disease Abnormal bones Metabolic bone disease Rickets Skeletal dysplasias Physeal/metaphyseal injury 3-year-old girl with rickets
108 Genu varum / Bowing Differential diagnosis: Exaggerated physiologic Blount disease Abnormal bones Metabolic bone disease Skeletal dysplasias Achondroplasia Physeal/metaphyseal injury 4-year-old boy with achondroplasia
109 Genu varum / Bowing Differential diagnosis: Exaggerated physiologic Blount disease Abnormal bones Metabolic bone disease Skeletal dysplasias Achondroplasia Physeal/metaphyseal injury 5-year-old boy with achondroplasia
110 Genu varum / Bowing Differential diagnosis: Exaggerated physiologic Blount disease Abnormal bones Metabolic bone disease Skeletal dysplasias Physeal/metaphyseal injury
111 Physeal/metaphyseal injury Chronic repetitive (overuse) injuries Physeal injury -> Bridge
112 Physeal/metaphyseal injury Chronic repetitive (overuse) injuries Physeal injury -> Bridge Can cause genu varum or valgum Depending on location of injury
113 Physeal/metaphyseal injury Chronic repetitive (overuse) injuries Physeal injury -> Bridge
114 Physeal/metaphyseal injury Chronic repetitive (overuse) injuries > Disruption of metaphyseal blood supply > Disruption of endochondral ossification 14-year-old competitive soccer player
115 Physeal/metaphyseal injury Chronic repetitive (overuse) injuries > Disruption of metaphyseal blood supply > Disruption of endochondral ossification 14-year-old competitive soccer player
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117 2-month follow up after rest
118 Physeal/metaphyseal injury 11 years Laor T. et. al. Physeal Widening in the Knee Due to Stress Injury in Child Athletes. AJR 2006
119 Physeal/metaphyseal injury 11 years Laor T. et. al. Physeal Widening in the Knee Due to Stress Injury in Child Athletes. AJR 2006
120 Physeal/metaphyseal injury 11 years 2 year follow up Laor T. et. al. Physeal Widening in the Knee Due to Stress Injury in Child Athletes. AJR 2006
121 Physeal/metaphyseal injury 11 years 17 years Laor T. et. al. Physeal Widening in the Knee Due to Stress Injury in Child Athletes. AJR 2006
122 Genu valgum
123 Genu Valgum / Knock Knees Angular deformity at the knee Apex of the deformity points toward the midline. Leg (below knee) deviates away from the midline. Common referral to orthopedic clinics Up-to-date, 2017
124 Genu Valgum / Knock Knees Angular deformity at the knee Apex of the deformity points toward the midline. Leg (below knee) deviates away from the midline. Common referral to orthopedic clinics Up-to-date, 2017
125 Genu Valgum Differential diagnosis: Exaggerated physiologic Physeal/metaphyseal injuries Abnormal bones Tumors Up-to-date, 2017
126 Genu Valgum Differential diagnosis: Exaggerated physiologic Physeal/metaphyseal injuries Abnormal bones Tumors Up-to-date, 2017
127 Exaggerated Physiologic Valgum Exaggeration of the normal age-related valgus Age: 3-5 yrs Bilateral & symmetric Normal stature Absent or mild symptoms 3-years
128 Exaggerated Physiologic Valgum Exaggeration of the normal age-related valgus Age: 3-5 yrs Bilateral & symmetric Normal stature Absent or mild symptoms Valgus 3-4 yrs nl = 8-12
129 Exaggerated Physiologic Valgum Exaggeration of the normal age-related valgus Age: 3-5 yrs Bilateral & symmetric Normal stature Absent or mild symptoms 3-years 9-years
130 Genu Valgum Differential diagnosis: Exaggerated physiologic Physeal/metaphyseal injuries Chronic repetitive (overuse) injuries Physeal injury -> Bridge Cozen Phenomenon Abnormal bones Tumors
131 Physeal Injury -> Bridge Causes Trauma most common cause Other causes: Infection Radiation Medications Tumors
132 Risk Factors of Bridge Formation Severity of injury Growth potential Younger / less skeletal maturity Anatomic site Contour of the physis & growth rate
133 Risk Factors of Bridge Formation Anatomic site:
134 Risk Factors of Bridge Formation Anatomic site: Distal radius Distal femur
135 Risk Factors of Bridge Formation Anatomic site: Distal radius Distal femur
136 Risk Factors of Bridge Formation Anatomic site: Distal radius smooth, uniplanar Distal femur
137 Risk Factors of Bridge Formation Anatomic site: Distal radius smooth, uniplanar Distal femur - undulating, multiplanar physis
138 Risk Factors of Bridge Formation Anatomic site: Distal radius smooth, uniplanar Distal femur - undulating, multiplanar physis
139 Risk Factors of Bridge Formation Anatomic site: Distal radius smooth, uniplanar Distal femur - undulating, multiplanar physis Physeal fx: Radius >>> Femur % -> Bridges : Femur >>> Radius
140 10 year old girl
141 9 month follow up 10-year-old girl with history of a distal femur fracture
142 Imaging Physeal Bridges Radiographs Directly visualized Indirect evidence Narrowing of the physis Growth recovery lines 10-year-old girl with history of a distal femur fracture
143 Imaging Physeal Bridges Radiographs Directly visualized Indirect evidence Narrowing of the physis Growth recovery lines 10-year-old girl with history of a distal femur fracture
144 Imaging Physeal Bridges Radiographs Directly visualized Indirect evidence Narrowing of the physis Growth recovery lines 10-year-old girl with history of a distal femur fracture
145 Imaging Physeal Bridges Radiographs Directly visualized Indirect evidence Narrowing of the physis Growth recovery lines Normal - parallel physis 10-year-old girl with history of a distal femur fracture
146 Imaging Physeal Bridges Radiographs Directly visualized Indirect evidence Narrowing of the physis Growth recovery lines Normal - parallel physis 10-year-old girl with history of a distal femur fracture
147 Imaging Physeal Bridges Radiographs Directly visualized Indirect evidence Narrowing of the physis Growth recovery lines Normal - parallel physis Abnormal Oblique, converge at physeal bridge 10-year-old girl with history of a distal femur fracture
148 Imaging Physeal Bridges Radiographs Directly visualized Indirect evidence Narrowing of the physis Growth recovery lines Normal - parallel physis Abnormal Oblique, converge at physeal bridge 10-year-old girl with history of a distal femur fracture
149 Imaging Physeal Bridges Radiographs Directly visualized Indirect evidence Narrowing of the physis Growth recovery lines Normal - parallel physis Abnormal Oblique, converge at physeal bridge 10-year-old girl with history of a distal femur fracture
150 Treatment of Physeal Bridges Resection
151 Treatment of Physeal Bridges Resection considered if: Existing or developing deformity
152 Treatment of Physeal Bridges Resection considered if: Existing or developing deformity > 2 years or 2 cm of remaining growth
153 Treatment of Physeal Bridges Resection considered if: Existing or developing deformity > 2 years or 2 cm of remaining growth Bridge occupies < 50% of the physeal area GRE
154 Treatment of Physeal Bridges Resection considered if: Existing or developing deformity > 2 years or 2 cm of remaining growth Bridge occupies < 50% of the physeal area GRE
155 Treatment of Physeal Bridges Resection considered if: Existing or developing deformity > 2 years or 2 cm of remaining growth Bridge occupies < 50% of the physeal area GRE
156 Treatment of Physeal Bridges Resection considered if: Existing or developing deformity > 2 years or 2 cm of remaining growth Bridge occupies < 50% of the physeal area Total Area of Physis
157 Treatment of Physeal Bridges Resection considered if: Existing or developing deformity > 2 years or 2 cm of remaining growth Bridge occupies < 50% of the physeal area Area of Bridge _ Total Area of Physis
158 Treatment of Physeal Bridges Resection considered if: Existing or developing deformity > 2 years or 2 cm of remaining growth Bridge occupies < 50% of the physeal area Area of Bridge _ Total Area of Physis = % of Physis Occupied by Bridge
159 Physeal Bridge Treatment options: Bridge resection Osteotomy to correct angular deformities
160 Physeal Bridge Treatment options: Bridge resection Osteotomy to correct angular deformities Contralateral epiphysiodesis
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168 Genu Valgum Differential diagnosis: Exaggerated physiologic Physeal/metaphyseal injuries Chronic repetitive (overuse) injuries Physeal injury -> Bridge Cozen Phenomenon Abnormal bones Tumors
169 Genu Valgum Differential diagnosis: Exaggerated physiologic Physeal/metaphyseal injuries Chronic repetitive (overuse) injuries Physeal injury -> Bridge Cozen Phenomenon Valgus deformity s/p proximal tibial fx Despite good alignment at fx site Burton A, et al. Cozen's phenomenon revisited. J Pediatr Orthop B Nov;25(6):
170 Genu Valgum Differential diagnosis: Exaggerated physiologic Physeal/metaphyseal injuries Chronic repetitive (overuse) injuries Physeal injury -> Bridge Cozen Phenomenon Valgus deformity s/p proximal tibial fx Despite good alignment at fx site Burton A, et al. Cozen's phenomenon revisited. J Pediatr Orthop B Nov;25(6):
171 Genu Valgum Differential diagnosis: Exaggerated physiologic Physeal/metaphyseal injuries Chronic repetitive (overuse) injuries Physeal injury -> Bridge Cozen Phenomenon Valgus deformity s/p proximal tibial fx Despite good alignment at fx site Burton A, et al. Cozen's phenomenon revisited. J Pediatr Orthop B Nov;25(6):
172 Genu Valgum Differential diagnosis: Exaggerated physiologic Physeal/metaphyseal injuries Chronic repetitive (overuse) injuries Physeal injury -> Bridge Cozen Phenomenon Valgus deformity s/p proximal tibial fx Despite good alignment at fx site Burton A, et al. Cozen's phenomenon revisited. J Pediatr Orthop B Nov;25(6):
173 Genu Valgum Differential diagnosis: Exaggerated Physiologic Physeal/metaphyseal injuries Chronic repetitive (overuse) injuries Physeal injury -> Bridge Cozen Phenomenon Most accepted theory Fx -> vascularity -> medial metaphyseal overgrowth Burton A, et al. Cozen's phenomenon revisited. J Pediatr Orthop B Nov;25(6):
174 Genu Valgum Differential diagnosis: Exaggerated Physiologic Physeal/metaphyseal injuries Abnormal bones Tumors
175 Genu Valgum Differential diagnosis: Exaggerated Physiologic Physeal/metaphyseal injuries Abnormal bones Metabolic bone disease Rickets 5-year-old boy with rickets
176 Genu Valgum Differential diagnosis: Exaggerated Physiologic Physeal/metaphyseal injuries Abnormal bones Metabolic bone disease Rickets 5-year-old boy with rickets
177 Genu Valgum Differential diagnosis: Exaggerated Physiologic Physeal/metaphyseal injuries Abnormal bones Metabolic bone disease Rickets 5-year-old boy with rickets
178 Genu Valgum Differential diagnosis: Exaggerated Physiologic Physeal/metaphyseal injuries Abnormal bones Metabolic bone disease Lysosomal storage disease Mucopolysaccharidosis IV (Morquio syndrome) Mucopolysaccharidosis IV
179 Genu Valgum Differential diagnosis: Exaggerated Physiologic Physeal/metaphyseal injuries Abnormal bones Metabolic bone disease Lysosomal storage disease Mucopolysaccharidosis IV (Morquio syndrome) Mucopolysaccharidosis IV
180 Genu Valgum Differential diagnosis: Exaggerated Physiologic Physeal/metaphyseal injuries Abnormal bones Metabolic bone disease Lysosomal storage disease Mucopolysaccharidosis IV (Morquio syndrome) Mucopolysaccharidosis IV
181 Genu Valgum Differential diagnosis: Exaggerated Physiologic Physeal/metaphyseal injuries Abnormal bones Metabolic bone disease Lysosomal storage disease Skeletal dysplasias Chondroectodermal dysplasia (Ellisvan Crevald) Ellis-van Crevald
182 Genu Valgum Differential diagnosis: Exaggerated Physiologic Physeal/metaphyseal injuries Abnormal bones Metabolic bone disease Lysosomal storage disease Skeletal dysplasias Chondroectodermal dysplasia (Ellisvan Crevald) Ellis-van Crevald
183 Genu Valgum Differential diagnosis: Exaggerated Physiologic Physeal/metaphyseal injuries Abnormal bones Metabolic bone disease Lysosomal storage disease Skeletal dysplasias Chondroectodermal dysplasia (Ellisvan Crevald) Ellis-van Crevald
184 Genu Valgum Differential diagnosis: Exaggerated Physiologic Physeal/metaphyseal injuries Abnormal bones Tumors Osteochondromas / Mutliple hereditary exostosis
185 Genu Valgum Differential diagnosis: Exaggerated Physiologic Physeal/metaphyseal injuries Abnormal bones Tumors Osteochondromas / Mutliple hereditary exostosis
186 Summary
187 Summary Normal developmental changes at the knee 1-year-old 3-year-old Varus Valgus
188 Summary Genu Varum Exaggerated Physiologic Blount Abnormal Bones Injuries Genu Valgum Exaggerated Physiologic Physeal/metaphyseal injuries Abnormal bones Tumors Physiologic Morquio Blount Osteochondromas
189 References Salenius P, et al. Development of the tibiofemoral angle in children. J Bone Joint Surg Am Mar;57(2): Sabharwal S. Blount disease. J Bone Joint Surg Am Jul;91(7): Ho-Fung V, et al. MRI evaluation of the knee in children with infantile Blount disease: tibial and extra-tibial findings. Pediatr Radiol Oct;43(10): Burton A, et al. Cozen's phenomenon revisited. J Pediatr Orthop B Nov;25(6): Laor T, et al. Physeal widening in the knee due to stress injury in child athletes. AJR Am J Roentgenol May;186(5):
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