Is There an Indication for Correcting a Valgus Knee?

  • Philip P. Roessler
  • Alan GetgoodEmail author


While most procedures in the treatment of patellofemoral instability address the static or dynamic stabilizers of the patella, there are still other factors that need to be considered during the process of preoperative decision-making. Limb malalignment and its resultant force vectors are one such important factor for normal biomechanical function of the lower extremity. Frontal plane valgus deformity is particularly important, as it may lead to chronic patellofemoral instability and lateral dislocation [1]. Consequently, soft tissue procedures performed with a background of such preexisting deformity show a higher rate of failure [2].


  1. 1.
    McWalter EJ, Cibere J, MacIntyre NJ, et al. Relationship between varus-valgus alignment and patellar kinematics in individuals with knee osteoarthritis. J Bone Joint Surg Am. 2007;89:2723–31. Scholar
  2. 2.
    Bruce WD, Stevens PM. Surgical correction of miserable malalignment syndrome. J Pediatr Orthop. 2004;24:392–6.CrossRefGoogle Scholar
  3. 3.
    Boden B, Pearsall A, Garrett W, Feagin J. Patellofemoral instability: evaluation and management. J Am Acad Orthop Surg. 1997;5:47–57.CrossRefGoogle Scholar
  4. 4.
    Hermans K, Claes S, Bellemans J. Valgus instability as a cause for recurrent lateral patellar dislocation: a new mechanism for patellofemoral instability? Acta Orthop Belg. 2013;79:495–501.PubMedGoogle Scholar
  5. 5.
    Eilert RE. Congenital dislocation of the patella. Clin Orthop Relat Res. 2001;389:22–9.CrossRefGoogle Scholar
  6. 6.
    Dejour D, Le Coultre B. Osteotomies in patello-femoral instabilities. Sports Med Arthrosc. 2018;26:8–15. Scholar
  7. 7.
    Frosch KH, Schmeling A. A new classification system of patellar instability and patellar maltracking. Arch Orthop Trauma Surg. 2016;136:485–97. Scholar
  8. 8.
    Puddu G, Cipolla M, Cerullo G, et al. Which osteotomy for a valgus knee? Int Orthop. 2010;34:239–47. Scholar
  9. 9.
    Phisitkul P, Wolf BR, Amendola A. Role of high tibial and distal femoral osteotomies in the treatment of lateral-posterolateral and medial instabilities of the knee. Sports Med Arthrosc. 2006;14:96–104. Scholar
  10. 10.
    Grelsamer RP, Klein JR. The biomechanics of the patellofemoral joint. J Orthop Sports Phys Ther. 1998;28:286–98. Scholar
  11. 11.
    Rosso F, Margheritini F. Distal femoral osteotomy. Curr Rev Musculoskelet Med. 2014;7:302–11. Scholar
  12. 12.
    Imhoff FB, Beitzel K, Zakko P, et al. Derotational osteotomy of the distal femur for the treatment of patellofemoral instability simultaneously leads to the correction of frontal alignment: a laboratory cadaveric study. Orthop J Sports Med. 2018;6:2325967118775664. Scholar
  13. 13.
    Collins B, Getgood AM, Alomar AZ, et al. A case series of lateral opening wedge high tibial osteotomy for valgus malalignment. Knee Surg Sports Traumatol Arthrosc. 2013;21:152–60. Scholar
  14. 14.
    Ranawat AS, Nwachukwu BU, Pearle AD, et al. Comparison of lateral closing-wedge versus medial opening-wedge high Tibial osteotomy on knee joint alignment and kinematics in the ACL-deficient knee. Am J Sports Med. 2016;44:3103–10. Scholar
  15. 15.
    Cole BJ, Sekiya JK. Surgical techniques of the shoulder, elbow and knee in sports medicine E-Book. Philadelphia, PA: Elsevier Health Sciences; 2013.Google Scholar
  16. 16.
    Woodacre T, Ricketts M, Evans JT, et al. Complications associated with opening wedge high tibial osteotomy—a review of the literature and of 15 years of experience. Knee. 2016;23:276–82. Scholar
  17. 17.
    Uhl JF, Gillot C. Anatomy of the Hunter's canal and its role in the venous outlet syndrome of the lower limb. Phlebology. 2015;30:604–11. Scholar
  18. 18.
    Pagenstert G, Wolf N, Bachmann M, et al. Open lateral patellar retinacular lengthening versus open retinacular release in lateral patellar hypercompression syndrome: a prospective double-blinded comparative study on complications and outcome. Arthroscopy. 2012;28:788–97. Scholar
  19. 19.
    Sabbag OD, Woodmass JM, Wu IT, et al. Medial closing-wedge distal femoral osteotomy with medial patellofemoral ligament imbrication for genu valgum with lateral patellar instability. Arthrosc Tech. 2017;6:e2085–91. Scholar
  20. 20.
    Saithna A, Kundra R, Modi CS, et al. Distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. A systematic review of the literature. Open Orthop J. 2012;6:313–9. Scholar
  21. 21.
    Purushothaman B, Agarwal A, Dawson M. Posttraumatic chronic patellar dislocation treated by distal femoral osteotomy and medial patellofemoral ligament reconstruction. Orthopedics. 2012;35:e1668–72. Scholar
  22. 22.
    Kwon JH, Kim JI, Seo D-H, et al. Patellar dislocation with genu valgum treated by DFO. Orthopedics. 2013;36:840–3. Scholar
  23. 23.
    Swarup I, Elattar O, Rozbruch SR. Patellar instability treated with distal femoral osteotomy. Knee. 2017;24:608–14. Scholar
  24. 24.
    Wilson PL, Black SR, Ellis HB, Podeszwa DA. Distal femoral valgus and recurrent traumatic patellar instability: is an isolated varus producing distal femoral osteotomy a treatment option? J Pediatr Orthop. 2018;38:e162–7. Scholar
  25. 25.
    Nha K-W, Ha Y, Oh S, et al. Surgical treatment with closing-wedge distal femoral osteotomy for recurrent patellar dislocation with genu Valgum. Am J Sports Med. 2018;46:1632–40. Scholar
  26. 26.
    Frings J, Krause M, Akoto R, et al. Combined distal femoral osteotomy (DFO) in genu valgum leads to reliable patellar stabilization and an improvement in knee function. Knee Surg Sports Traumatol Arthrosc. 2018;39:1756. Scholar

Copyright information

© ESSKA 2020

Authors and Affiliations

  1. 1.Fowler Kennedy Sports Medicine Clinic, Western UniversityLondonCanada

Personalised recommendations