Genu Valgum

GENU VALGUM

Q. 1

Genu valgus deformity seen when?

 A

 Long axis of tibia n fibula moves medial to long axis of femur

 B

 Long axis of tibia n fibula moves lateral to the long axis of femur

 C

 Long axis of femur is posterior to tibia and fibula

 D

 Long axis of femur is anterior to tibia and fibula

Q. 1

Genu valgus deformity seen when?

 A

 Long axis of tibia n fibula moves medial to long axis of femur

 B

 Long axis of tibia n fibula moves lateral to the long axis of femur

 C

 Long axis of femur is posterior to tibia and fibula

 D

 Long axis of femur is anterior to tibia and fibula

Ans. B

Explanation:

Long axis of tibia and fibula moves lateral to the long axis of femur
REF: http://www.upstate.edu/cdb/education/grossanat/limbs8.shtml

ALIGNMENT OF THE KNEE

1. Normal Alignment

  • Slight valgus position: Angle between longitudinal axis of femur and tibia is 170 degree opened laterally
  • Q angle- is a measure of the axis of pull of the quadriceps tendon and that of the ligament of the patella. The former is measured by a line drawn from the ASIS to center of patella. The latter is determined by a line drawn from the tibial tuberosity to the center of the patella. The normal Q angle is between 15-200. This angle is somewhat greater in females than males. A Q angle much greater than normal means the patella will track in a lateral direction rubbing against the lateral femoral condyle causing Patella pain.

2. Abnormal Alignment

  • Genu Valgum ( Knock Knee)

            – Tibia abducted with respect to femur

            – Angle between longitudinal axes of bones less than 1700

  • Genu Varum (Bow Leg)

            – Tibia adducted with respect to femur

            – Angle between longitudinal axes of bones greater than 1700

Genu valgum: distance between medial malleoli < 8cms with knees touching and patella facing outwards

Genu varum: distance between medial malleoli < 6cms when heels are touching

Genu recurvatum is a deformity in the knee joint,so that the knee bends backwards. In this deformity, excessive extension occurs in the tibiofemoral joint. Genu recurvatum is also called knee hyperextension and back knee

Tibia vara: also known as blount’s disease


Q. 2

Genu valgus deformity occur when :

 A

Long axis of tibia and fibula moves medial to long axis of femur

 B

Long axis of tibia and fibula moves lateral to the long axis of femur

 C

Long axis of femur is posterior to tibia and fibula

 D

Long axis of femur is anterior to tibia and fibula

Q. 2

Genu valgus deformity occur when :

 A

Long axis of tibia and fibula moves medial to long axis of femur

 B

Long axis of tibia and fibula moves lateral to the long axis of femur

 C

Long axis of femur is posterior to tibia and fibula

 D

Long axis of femur is anterior to tibia and fibula

Ans. B

Explanation:

In genu valgum or knock-knee deformity, as the mechanical axis shifts laterally, pathological stress is placed on the lateral femur and tibia, inhibiting growth and possibly leading to a vicious cycle.

Not only is physeal growth inhibited, but also the Hueter-Volkmann effect upon the entire epiphysis prevents its normal expansion.

According to the Hueter-Volkmann principle, continuous or excessive compressive forces upon the epiphysis have an inhibitory effect upon growth.

Consequently, growth in the lateral condyle of the femur is suppressed globally, resulting in a shallow femoral sulcus and a propensity for the patella to tilt and subluxate laterally.


Q. 3

Pappu, 7 yrs old young boy, had fracture of lateral condyle of femur. He developed malunion as the fracture was not reduced anatomically. Malunion will produce:

 A

Genu valgum

 B

Genu varum

 C

Genu recurvatum

 D

Dislocation of knee

Q. 3

Pappu, 7 yrs old young boy, had fracture of lateral condyle of femur. He developed malunion as the fracture was not reduced anatomically. Malunion will produce:

 A

Genu valgum

 B

Genu varum

 C

Genu recurvatum

 D

Dislocation of knee

Ans. A

Explanation:

Due to decrease growth over the lateral aspect in relation to the medial aspect, the person may develop Genu valgum.

Ref: Essential Orthopedics By J Maheswari, 2nd Edition, Page 274


Q. 4

Most common cause of genu valgum in children is ‑

 A

Osteoarthritis

 B

Rickets

 C

Paget disease

 D

Rheumatoid arthritis

Q. 4

Most common cause of genu valgum in children is ‑

 A

Osteoarthritis

 B

Rickets

 C

Paget disease

 D

Rheumatoid arthritis

Ans. B

Explanation:

Ans. is ‘b’ i.e., Rickets

o Genu valgum (also known as knock knee) is a condition where knees are abnormally approximated and ankles are abnormally divergent.

o It is caused due to softening of bones or damage to lateral Femoral epiphysis

Out of given options ‑

o Most common cause in children is Rickets.

o Other diseases given in option are seen in elderly.


Q. 5

Genu valgum deformity is seen in all except ‑

 A

Rickets

 B

Bone Dysplasia

 C

Rheumatoid arthritis

 D

Medial compartment osteoarthritis

Q. 5

Genu valgum deformity is seen in all except ‑

 A

Rickets

 B

Bone Dysplasia

 C

Rheumatoid arthritis

 D

Medial compartment osteoarthritis

Ans. D

Explanation:

Ans. is ‘d’ i.e., Medial compartment osteoarthritis

Genu valgum (knock knee)

Genu valgum is a condition in which the lower legs are positioned at an outward angle with abnormal approximation of knees and abnormally divergent ankles. Genu valgum is a condition in which the knees touch, but the ankles do not touch. Normally, a child is born with genu varum. Therefore, neonates and infants normally have genu varum. When the infant begins to stand and walk, the lower limb straighten and this physiological genu varus disappear at around years of age. The leg become straight. Then, between the age of 2-3 years genu valgum starts developing gradually with maximum genu – valgum of 12° at the age of 31/4 years. Finally genu-valgum spontaneously get corrected by the age of 7 years to that of normal adult genu valgum of 7 – 8°. So upto 7 years, exagerated genu valgum is physiological. If this exaggerated genu valgum persists after 8 years, then it is pathological genu valgum.


Q. 6

Genu valgum deformity is seen in all except ‑

 A

Rickets

 B

Bone Dysplasia

 C

Rheumatoid arthritis

 D

Medial compartment osteoarthritis

Q. 6

Genu valgum deformity is seen in all except ‑

 A

Rickets

 B

Bone Dysplasia

 C

Rheumatoid arthritis

 D

Medial compartment osteoarthritis

Ans. D

Explanation:

Ans. is ‘d’ i.e., Medial compartment osteoarthritis


Q. 7

A 7 year old boy presented with  circumduction gait, anterior knee pain, and patellofemoral instability. On examination,following picture was seen.Diagnose this  deformity: 

 A

Genu varum 

 B

 Genu valgum 

 C

 Genu recurvatum 

 D

Clergyman’s knee

Q. 7

A 7 year old boy presented with  circumduction gait, anterior knee pain, and patellofemoral instability. On examination,following picture was seen.Diagnose this  deformity: 

 A

Genu varum 

 B

 Genu valgum 

 C

 Genu recurvatum 

 D

Clergyman’s knee

Ans. B

Explanation:

Ans:B.)Genu valgum

Genu valgum( “knock-knee”)

  • It is a condition in which the knees angle in and touch one another when the legs are straightened.
  • The term originates from the Latin genu, “knee”, and valgus which actually means bent outwards, but in this case, it is used to describe the distal portion of the knee joint which bends outwards and thus the proximal portion seems to be bent inwards.

Pathophysiology:

  •  In genu valgum, as the mechanical axis shifts laterally, pathologic stress is placed on the lateral femur and tibia, inhibiting growth .
  • According to the Hueter-Volkmann principle, continuous or excessive compressive forces on the epiphysis have an inhibitory effect on growth. Consequently, growth in the lateral condyle of the femur is suppressed globally, resulting in a shallow femoral sulcus and a propensity for the patella to tilt and subluxate laterally.
  • Persons with knock knees often have collapsed inner arches of their feet, and their inner ankle bones are generally lower than their outer ankle bones.
  • Adults with uncorrected genu valgum are typically prone to injury and chronic knee problems such as chondromalacia and osteoarthritis. 

Etiology:

  • Toddlers aged 2-6 years may have physiologic genu valgum. For this age group, typical features include ligamentous laxity, symmetry, and lack of pain or functional limitations.
  • In contrast, adolescent idiopathic genu valgum is not benign or self-limiting. Teenagers may present with a circumduction gait, anterior knee pain, and, occasionally, patellofemoral instability.
  • Various other conditions, including postaxial limb deficiencies, genetic disorders such as Down syndrome, hereditary multiple exostoses, neurofibromatosis, and vitamin D–resistant rickets ,Marfan syndrome, osteogenesis imperfecta and rheumatologic diseases may cause persistent and symptomatic genu valgum.

Treatment:

  • Physiologic genu valgum should be treated expectantly.
  • Bracing and therapy are inadequate to meet these goals.
  • Surgical intervention is the only successful intervention for correcting the problem. Surgical options include osteotomy or growth manipulation (hemiepiphysiodesis).

Abnormal Alignment of the Knee Joint

  • Genu Valgum ( Knock Knee)
    • Tibia abducted with respect to femur
  • Genu Varum (Bow Leg)
    • Tibia adducted with respect to femur
  • Genu recurvatum
    • It is a deformity in the knee joint,so that the knee bends backwards. In this deformity, excessive extension occurs in the tibiofemoral joint. Genu recurvatum is also called knee hyperextension and back knee

Q. 8

Identify the condition of the lower limbs as shown in the photograph below ? 

 A

Knock knees.

 B

Genu varum.

 C

Genu recurvatum.

 D

Coxa vara

Q. 8

Identify the condition of the lower limbs as shown in the photograph below ? 

 A

Knock knees.

 B

Genu varum.

 C

Genu recurvatum.

 D

Coxa vara

Ans. A

Explanation:

Genu valgum, commonly called “knockknee“, is a condition in which the knees angle in and touch one another when the legs are straightened. Individuals with severe valgus deformities are typically unable to touch their feet together while simultaneously straightening the legs.

Knock knees are angular deformities at the knee, in which the head of the deformity points inward. A standing child whose knees touch, but whose ankles do not, is usually said to have knock knees. During early childhood, knock knees are a part of normal growth and development.The condition usually becomes apparent when a child is 2 to 3 years old, and it may increase in severity until about age 4. It usually self-corrects by the time a child is about 7 or 8 years old. But if the condition doesn’t appear until a child is 6 or older, it could be a sign that she has an underlying bone disease.

During early childhood, knock-knees actually help a child to maintain balance, particularly when she begins to walk, or if her foot rolls inward or turns outward. When a child has knock knees, both knees usually lean inward symmetrically. One knee, however, may “knock” less than the other, or may even remain straight.

Knock knees usually correct themselves by the time a child is 7 or 8 years old. Occasionally, they persist into adolescence. The condition is slightly more common in girls, although boys can develop it, too.



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