Coronal plane deformity around the knee in the skeletally immature population: A review of principles of evaluation and treatment

Core Tip

Core Tip: Physiological angulation requires no treatment other than clinical observation. If the clinical picture is doubtful, a long-standing X-ray of the lower limb is required for clarification. Once a pathological alignment is determined by X-ray, a differential diagnosis is needed to establish whether the deformity is idiopathic or a secondary condition. Furthermore, any associated deformities in other planes (e.g., rotation or length difference) should be evaluated. Pathological alignment should be treated for at least two reasons: To interrupt the vicious circle described by the Hueter-Volkmann law and to prevent premature degeneration of the joint. Both of these conditions stem from abnormal load distribution. Guided growth should be considered every time a coronal deformity of the knee is foreseen in a skeletally immature patient. Although comparative studies are lacking in the literature, this technique has a high success rate with few complications and a low impact on the patient and the family.