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• #1 Approach to the child with knock-knees – UpToDate

  https://www.uptodate.com/contents/approach-to-the-child-with-knock-knees

  Knock-knees (genu valgum) is an angular deformity at the knee where the apex of the deformity points toward the midline. […] Pathologic causes of knock-knees include posttraumatic (eg, Cozen fracture), rickets (eg, renal osteodystrophy), skeletal dysplasias, mucopolysaccharidosis, and neoplasms. […] Unlike physiologic knock-knees, these conditions generally do not improve over time and may require treatment with bracing or surgery. […] An understanding of normal physiologic development of the lower extremity is essential to differentiation of physiologic from pathologic deformities. Lower-extremity alignment goes through a predictable progression from varus (bow-legs), to neutral, to valgus (knock-knees), and back towards neutral over the first seven years of life.

• #2

  https://www.orthobullets.com/pediatrics/4052/genu-valgum-knocked-knees

  Genu Valgum is a normal physiologic process in children which may also be pathologic if associated with skeletal dysplasia, physeal injury, tumors or rickets. […] Diagnosis is made clinically with presence of progressive genu valgum after the age of 7. […] Treatment is observation for genu valgum 15 degrees in a child 7 years of age. Surgical management is indicated for severe and progressive genu valum in a child 7 years of age. […] Pathophysiology includes physiologic progression of coronal alignment, with genu varum at 2 years of age, neutral alignment around 2 years, and genu valgum peaking at 3-4 years to a tibiofemoral angle of 15-20 degrees. […] Genu valgum rarely worsens after age 7; after age 7, valgus should not be worse than 12 degrees of genu valgum. […] After age 7, the intermalleolar distance should be assessed.

• #3 Treating Idiopathic Genu Valgum (Knock Knees)

  https://consultqd.clevelandclinic.org/treating-idiopathic-genu-valgum-knock-knees

  Genu valgum (knock knees) represents one of the most common angular deformities encountered by pediatric orthopaedic specialists. […] Underlying causes of the pathologic form of genu valgum include skeletal dysplasia, prior growth plate injury, vitamin D deficiency, and infection. […] However, the vast majority of cases are idiopathic. […] The method of treating idiopathic genu valgum depends on both the timing of presentation and the severity of the deformity. […] Transient hemiepiphysiodesis is the most common of these growth modulation procedures. […] These techniques all rely on the Hueter-Volkmann principle, which states that increased mechanical stress on a physis leads to decreased bone growth. […] In the case of genu valgum, by applying hardware to the medial distal femoral and/or medial proximal tibial physes, growth is slowed medially but allowed to progress in the lateral physes. Therefore, coronal angulation is corrected over time.

• #4 Knock Knee: Causes, Symptoms, Diagnosis and Treatment | HSS

  https://www.hss.edu/condition-list_knock-knee.asp

  Knock knee can be caused by an underlying congenital or developmental disease or arise after an infection or a traumatic knee injury. Common causes of knock knees include: […] Knock knees that remain outside of these normal developmental growth patterns may be caused by disease, infection or other conditions. If the angle of the legs from hip to foot falls outside normal patterns, worsens over time, or is present on only one side of the body, this suggests a person has a more serious form of knock knees, and further evaluation by an orthopedic specialist may be necessary. Surgery may be needed to treat the condition. […] In particular, adult patients who have been knock-kneed for many years often overload the outside (lateral compartment) of the knee, and stretch the inside (medial collateral ligament MCL). These forces can cause pain, knee instability (including complex patellofemoral instability) and arthritis.

• #5 Knock Knees | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/knock-knees

  Knock knees (genu valgum) is a condition in which the knees tilt inward while the ankles remain spaced apart. The condition is slightly more common in girls, though boys can develop it too. […] In rare cases, knock knees could be a sign of an underlying bone disease, particularly when the condition appears for the first time when a child is 6 or older. […] Many children develop knock knees during early childhood. As they begin to walk, an inward tilt at the knees can help children balance. This stance also helps if one or both of their feet roll inward or turn outward. […] Less often, knock knees is caused by a more serious disorder: Genetic conditions such as skeletal dysplasias or metabolic bone disease such as rickets can cause knock knees. […] If your child has knock knees along with any of the following symptoms, they may have a more serious condition: Knock knees that become apparent before age 2 or after age 7.

• #6 KNOCK KNEES (GENU VALGUM): SYMPTOMS, CAUSES, DIAGNOSES, AND TREATMENT | Mya Care

  https://myacare.com/blog/knock-knees-genu-valgum-symptoms-causes-diagnoses-and-treatment

  Knock knees, or genu valgum, is abnormal knee alignment that is frequently seen in children, and less commonly in adults. Patients with genu valgum have an excessive inward alignment of their knees. […] Pathologic knock knees are those that are severe, persist beyond 8 years of age, or start developing first during adulthood. These are almost always associated with other medical conditions like obesity, vitamin D deficiency, calcium deficiency, arthritis, or knee joint infection or trauma. […] Treating pathologic knock knees early can help prevent future complications (like osteoarthritis) and deformities. […] As opposed to physiologic knock knees seen during childhood, pathologic knock knees usually have one or more underlying causes: Rickets (soft bones due to vitamin D and calcium deficiency), Obesity, Bone tumors, Arthritis, Osteomyelitis (bone infection), Kidney problems, Metabolic illnesses, Genetic and developmental abnormalities, Injury to the bones growth plate during childhood, Abnormal joint healing after trauma.

• #7 Pediatric Genu Valgum: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/1259772-overview

  Genu valgum is the Latin-derived term used to describe knock-knee deformity. Whereas many otherwise healthy children have knock-knee deformity as a passing trait, some individuals retain or develop this deformity as a result of hereditary or genetic disorders or metabolic bone disease. […] In genu valgum, as the mechanical axis shifts laterally, pathologic stress is placed on the lateral femur, meniscus, and tibia, inhibiting growth and potentially leading to a vicious circle. […] Not only is physeal growth inhibited, but also the Hueter-Volkmann effect is exerted upon the entire hemiepiphysis (lateral femoral condyle), preventing its normal expansion. According to the Hueter-Volkmann principle, continuous or excessive compressive forces on the epiphysis have an inhibitory effect on growth.

• #8

  https://www.orthobullets.com/pediatrics/4052/genu-valgum-knocked-knees

  Lateral deviation of mechanical axis is characterized by decreased growth from lateral physis relative to medial physis. […] Patellar instability is associated with increased Q-angle and shallow lateral femoral sulcus, with lateral femoral condyle growth suppressed, predisposing to lateral subluxation. […] Associated conditions include bilateral genu valgum which can be physiologic or due to renal osteodystrophy, skeletal dysplasia, or unilateral genu valgum from physeal injury, benign tumors, or fibular hemimelia. […] The mechanical axis should pass through the center of the knee, and lateral deviation in genu valgum subjects the lateral femoral condyle and lateral tibia plateau to increased loads. […] Mechanical loading on physis modulates growth, with compression inhibiting growth and distraction stimulating growth.

• #9 Pediatric Genu Valgum: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/1259772-overview

  In children (of any age) with pathologic valgus, when the mechanical axis deviates laterally into zone +2 or beyond the lateral compartment of the knee (zone +3), regardless of the etiology, a number of clinical problems may ensue. […] Because patellar dislocation reflects an insidious and progressive growth disturbance, nonoperative management, with reliance on physical therapy and bracing, is of little value. […] The lifelong valgus knee presents a daunting challenge to the adult reconstructive orthopedist. Total knee arthroplasty may be fraught with complications, including persistent malalignment, neurovascular compromise, patellar instability, and premature loosening of the prosthetic components. […] Correction of genu valgum and neutralization of the forces across the knee are the goals of early and, if necessary, repeated intervention, which forestalls the need for more invasive adult reconstructive procedures.

• #10 Can Knock Knees Be Corrected in Adults? | HSS

  https://www.hss.edu/conditions_surgery-knock-knee-correction-adults.asp

  Knock knee is an improper alignment of the knee joint. In adults, it can lead to knee pain and premature degeneration of the knee joint. […] There are many causes for genu valgum (knock knees). Most cases are congenital, where people are born with the deformity, and it becomes more noticeable with time. An injury to the growth plate in childhood can also lead to knock knees. Knock knees can be surgically corrected. The surgical technique used may vary depending on age. […] Knock knees can cause the kneecaps to be off-center, which increases pressure and pain in the front of the knee. Knock knee alignment places high stresses on the outside (lateral side) of the knee, causing additional knee pain. These stresses often lead to knee arthritis. […] The deformity can get worse over time. In children the deformity can progress with growth. If arthritis is present, the deformity can progress as the joint wears out further. In adults the medial ligaments of the knee can stretch and cause greater deformity. Fixing the problem early will avoid progression of this condition.

• #11 Knock Knees | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/knock-knees

  The vast majority of children with knock knees get better without treatment and have a very positive long-term outlook. For children who have surgery for severe forms of the condition, the outlook is also excellent. […] Some children with severe knock knees that doesn’t improve or is due to an underlying condition (pathologic valgus), and who do not receive treatment, may over time develop knee pain, meniscal tears, patellar (kneecap) dislocation, or cartilage damage (arthritis).

• #12 Knock Knees | International Center for Limb Lengthening

  https://www.limblength.org/conditions/knock-knees/

  Knock knees are legs that curve inward at the knee, often preventing the ankles from coming together without shifting one knee in front of the other. […] In adults, knock knees do not resolve spontaneously, but rather tend to worsen as arthritis leads to further malalignment. Knock knees in adults are an independent risk factor for knee joint degeneration and pain. […] In adults, knock knees can be caused by trauma or infection, arthritis or residual effects from pediatric orthopedic disease. […] The best way to diagnose knock knees is by taking a standing X-ray, and drawing the straight line on the image from the hip to the ankle. If that line passes to the outside of the knee, there is genu valgum present. […] The aim of treatment will be to correct limb alignment, stop disease progression, and reduce the risk of joint degeneration.

• #13 Your Child’s Knocked Knees: Everything You Need to Know

  https://www.jeremyburnhammd.com/knock-knees-knocked-knees-valgus/

  Growth plate tethering or hemi-epiphysiodesis involves shutting down one side of the growth plate near the knee so that the other side can catch up. This is also known as guided growth surgery. […] Distal femoral osteotomy involves cutting and repositioning the thighbone (femur) itself. […] Even without treatment, the vast majority of children with knock knees get better and have a favorable long-term prognosis. […] Children with severe knock knees that do not improve or are caused by an underlying disease (pathological valgus) who do not receive treatment may develop knee pain, meniscal tears, patellar dislocation, or cartilage damage (arthritis) as they get older. […] Knock knee can occur due to either too rapid of growth of one side of the growth plate, or too slow of growth of one side of the growth plate. Some degree of knock knee is normal in children. Pathologic valgus (excessive or persistent knock knee) can be due to underlying conditions such as arthritis and rickets. […] In these cases, surgery may be needed to correct the valgus knee alignment. In younger patients (age 10-13) guided growth can be used to help realign the bone as the patient is growing. In adult patients, osteotomy surgery (realignment of the bone) can be performed to straighten out the leg.

• #14 Knock Knees – New Albany, Ohio – JIS Orthopedics

  https://jisortho.com/specialties/knee/knock-knees

  Knock knees (also known as knock knee syndrome or genu valgum) is a condition where the knees angle in and touch each other when the legs are straightened. This can lead to an altered gait and other complications if not properly addressed. […] Several factors can contribute to the development of knock knees: […] The misalignment can cause pain in the knees, hips, and ankles, especially if the knees bend excessively inward. […] The altered biomechanics of your legs can increase the likelihood of arthritis in the knee. […] Treatment for knock knees depends on the severity of the condition and the underlying cause. Common treatment options include: […] In severe cases, especially in adults, surgical intervention may be necessary to correct the alignment of the knees.

• #15 Knock Knees: Informative Article MSK Clinic Manchester Burnley

  https://mymskclinic.co.uk/knock-knees/

  It is important to mention factors such as congenital or developmental diseases, metabolic bone disorders, or calcium deficiency. […] If the angle of the legs from hip to foot falls outside normal patterns, worsens over time, or is present on only one side of the body, this suggests a person has a more serious form of knock knees. […] In severe cases, surgery may be necessary to correct the condition. […] There are a host of complications with this condition including secondary effects on other joints including pain and arthritis over time if left untreated. […] Often the hip or ankles are forced to compensate for the misalignment of the knees, with extra strain on the joint, leading to pain and discomfort. […] Knee pain from patellofemoral maltracking and instability. […] In adults, a variety of factors, including obesity, osteoarthritis, injury, or a congenital condition.

• #16 Your Child’s Knocked Knees: Everything You Need to Know

  https://www.jeremyburnhammd.com/knock-knees-knocked-knees-valgus/

  An orthopedic doctor and knee specialist will obtain the medial history and patient family history. They will then perform a detailed physical examination of the patients lower extremity, knees, and legs. Knee alignment will be assessed in the standing, sitting, and walking positions. Imaging tests including x-ray, alignment x-ray, and possible MRI or CT scan will be obtained. […] In most cases, knock knees is a harmless condition that does not require treatment. However, in some cases, gradual correction may be recommended. This can be done with the help of braces or orthotic devices. […] For most children, knock-knee is nothing more than a cosmetic issue, and no treatment is necessary, especially if they are dealing with slightly knocked knees. However, in some cases, the condition can lead to pain or difficulty walking. For these children, surgery may be recommended.

• #17

  https://www.orthobullets.com/pediatrics/4052/genu-valgum-knocked-knees

  The classification of genu valgum is not uniform and is based on underlying etiology. […] Physiologic genu valgum must be differentiated from pathologic causes, including obesity, excessive femoral anteversion, and metabolic conditions. […] Medical and family history can help differentiate between physiological and pathological etiology. […] The vast majority of physiological genu valgum will resolve spontaneously, and medical management of underlying etiology may slow progression. […] Eight-plate hemiepiphysiodesis shows a 95% complete correction for idiopathic cases and 80% for pathological cases. […] Idiopathic genu valgum has a better prognosis than pathological etiology with hemiepiphysiodesis, showing a higher rate of complete correction and fewer complications. […] Physiologic genu valgum resolves spontaneously in the vast majority by age of 7.

• #18 KNOCK KNEES (GENU VALGUM): SYMPTOMS, CAUSES, DIAGNOSES, AND TREATMENT | Mya Care

  https://myacare.com/blog/knock-knees-genu-valgum-symptoms-causes-diagnoses-and-treatment

  Treating pathologic knock knees early on can prevent permanent deformity and later development of osteoarthritis (joint damage). […] Surgery is not usually needed to treat knock knees. However, in those with worsening knock knees, severe angulation, and those who are suffering from debilitating symptoms, surgery might be the only solution.

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