TREATMENT OF SEVERE TORSIONAL MALALIGNMENT SYNDROME

Over a 7-year period (1984-1991), nine patients (aged 10-18 years) wit h 13 involved extremities were operatively treated for symptomatic sev ere torsional malalignment of the lower extremity and associated patel lofemoral pathology. Physical examination and analysis of gait reveale d severe rotational deformity characterized by excessive femoral antev ersion and external tibial torsion, The cosmetic and functional pathol ogic effect of this torsional malalignment was centered about the knee joint. In all patients, conservative treatment, including therapy for muscle strengthening and nonsteroidal medication, was unsuccessful in alleviating suspected patellofemoral pain. Subsequent definitive oper ative treatment in all 13 extremities consisted of corrective osteotom ies, internally rotating the distal part of the tibia or externally ro tating the distal part of the femur or both. Osteotomies were performe d as close to the knee joint as possible. No additional soft-tissue pr ocedures were performed directly to affect patellar tracking, All oste otomies healed without complications, At an average followup of 2 year s + 7 months (range, 18-48 months) overall, patients had an improvemen t in gait pattern, extremity appearance, and a marked decrease in knee pain.