"Malalignment Syndrome"

Fourteen children (19 feet) ranging in age from 2.1 to 17.0 years (mean, 7.6 years) underwent tibial osteotomy for treatment of congenital talipes equinovarus (CTEV). The indications for tibial osteotomy were persistent or recurrent equinovarus deformity and internal rotation of the foot (medial malalignment syndrome), in most cases with severe distortion of the hindfoot joints resulting from previous operations. In 12 feet (9 children), bi- or triplanar supramalleolar osteotomy for the correction of all the elements of the deformity was performed...

Retropatellar pain often accompanies malalignment syndromes and frequently is attributed to excessive patellofemoral contact stresses. Elevation (anterior displacement) of the tibial tubercle has been recommended to relieve these conditions. The degree to which patellar contact forces are decreased and the extent to which elevation alters medial-lateral forces have not been studied directly. We performed anterior translation of the tibial tubercle in knees from cadavers and measured the effect on the magnitude of the three-dimensional patellofemoral contact force with use of a specially designed 6-degrees-of-freedom force transducer, with the natural patellar articular surface in place...

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In 29 patients with patellofemoral complaints paired values of Q-angle and internal hip rotation were determined. In addition the patellar height index of Insall & Salvati (1971) was calculated from measurements on lateral radiographs of the knees. Both Q-angle and internal hip rotation were significantly higher in women than in men and there was a statistically significant correlation between these two measurements. There was no significant correlation between Q-angles and patellar height indexes. As external hip rotation can generally be taken as a measure of internal femoral torsion, these findings favour the hypothesis of a torsional malalignment syndrome of the patellofemoral joint...

Eighteen patients (26 knees) giving a history of patellar dislocation and/or subluxation and continued patellar symptoms underwent evaluation to determine the efficacy of their rehabilitation programs. Four-channel cine-electromyography was utilized to assess the relative muscular effort of the vastus medialis, vastus lateralis, vastus medialis obliquus, and rectus femoris in a series of exercises. Ten degrees of flexion of the knee reduced effective muscle effort in the vasti group to an average of 1/4 of the muscle effort demonstrated in full extension of the knee...

Patellar pain must be separated from other causes of internal derangement of the knee by a careful history and precise examination followed by appropriate investigations. Once the cause of the pain is determined, malalignment or malposition of the patella must be sought. The Merchant view of the patellar femoral joint is recommended in this regard to demonstrate patellar incongruence. The malalignment syndrome may or may not show the pathologic changes described as "chondromalacia" and respond particularly well after proximal patellar realignment...

Running popularity has risen dramatically in the last decade with a corresponding increase in running injuries. This article discusses the characteristics, presentation and conservative management of one of the most common running injuries: the chondromalacia patellae syndrome. This is more accurately referred to as a patellar malalignment syndrome since malalignment affecting the patella is the primary cause of pathology while cartilage damage is the possible long-term effect. This injury is preventable with anticipatory guidance regarding running practices and it usually responds well to a therapeutic regimen involving salicylates, muscular strengthening exercises and structural support...

At knee extension on the Cybex Machine II (Lumex, Co. Ltd.), electromyograms (EMG) from the vastus medialis (M) and the vastus lateralis (L) were picked up by surface electrodes. The L/M ratio was calculated by the integrated value of the EMG and the power spectrum dealt with the frequency analysis of the EMG. There was a correlation between the L/M ratio and Q angle for the normal group, a constant relation for the hypermobile patella group, and an inverse correlation for the group with recurrent subluxation of patella...

Orthotic devices have a multitude of applications. To properly prescribe them, one must have a clear understanding of the biomechanics of the lower limbs. These devices can support, correct, and prevent many pathologic conditions. The author has had experience with 235 patients, utilizing stance-phase, molded, thermoplastic orthotic devices. One hundred seventy-six patients responded to a questionnaire. Almost 80% of the patients experienced at least 50% improvement of their symptoms. With careful analysis, these devices not only can improve lower-segment malalignment syndromes in the athletic population but can also give relief to the patient with a painful foot and prevent serious ulcerations in the diabetic or rheumatoid patient...

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The primary inadequacy in the treatment of patellofemoral pain in children has been the inability to translate distinct problems recognized during physical examination into a specific clinical classification. Using a classification system based on etiology rather than symptoms allows the clinician to proceed with treatment based on a specific diagnosis. The majority of patellofemoral pain in children is caused by trauma and malalignment syndromes (or a combination of both) and can usually be managed successfully with nonoperative methods...

External rotation of both a structural and functional nature occurs in the lower limb of some patients with club feet. These external rotational deformities are due to two unrecognized and untreated combined deformities within the hindfoot and mid-foot: hindfoot varus and talo-navicular subluxation. If allowed to persist, they will eventually produce external rotation above the level of the ankle. This results in a condition that may be named "The Medial Malalignment Syndrome."

No abstract text is available yet for this article.