Key-Hole Surgery For Correction Of Knock Knee

Key-hole surgery, also known as arthroscopic surgery, is a minimally invasive surgical procedure that uses small incisions and a camera to correct various knee conditions, including a knock knee. Knock knees, also known as genu valgum, is a condition where the knees come together while the feet are apart. It is characterized by medial angulation of the tibia and femur bones, causing the knees to touch while standing with the feet apart. Continue reading to learn more about knock knee surgery!

Symptoms Of Knock Knees

Knock knees can be a normal developmental variation in children but can be a sign of an underlying condition in adults. Symptoms of knocked knees include:

• Knees are touching or nearly touching when standing with feet together.

• Gait abnormalities, such as walking with a waddling or swaying motion.

• Knee pain or discomfort, especially during physical activity or prolonged standing.

• Joint instability or weakness, which can lead to falls or difficulty with balance

• Reduced range of motion in the hips or ankles due to compensating for the knee misalignment

• The appearance of a wide gap between the feet and ankles when standing with knees together

• Fatigue or muscle weakness in the legs, especially during physical activity.

If you are experiencing any of these symptoms, you must consult a healthcare professional for an accurate diagnosis and knock knee surgery or treatment plan.

Causes Of Knock Knees

Several factors can cause knock knees, including:

• Developmental factors: Knock knees are common in young children, particularly those between the ages of 2 and 5, as their legs develop and grow.

• Genetics: Knock knees can sometimes be inherited from family members.

• Medical conditions: Certain medical conditions, such as rickets, osteomyelitis, or Blount's disease, can lead to the development of knock knees.

• Obesity: Excess weight can put extra pressure on the knees, leading to the development of knock knees.

• Injury: Trauma to the knee joint, such as a fracture or ligament tear, can cause the knee to become misaligned.

• Arthritis: Certain types of arthritis, such as rheumatoid arthritis or osteoarthritis, can lead to joint damage and knee misalignment.

• Neuromuscular disorders: Conditions that affect the nerves and muscles, such as cerebral palsy, can cause muscle imbalances that lead to knock knees.

• Poor posture: Standing or walking with poor posture can cause misalignment of the knees over time.

• Vitamin D deficiency: Lack of vitamin D can lead to bone softening, which can cause knock knees in children.

Knock Knees Diagnosis

Diagnosing knock knees typically involves a physical examination and medical history review. The healthcare professional may also use one or more of the following diagnostic tools:

• X-rays: This imaging test provides a detailed picture of the knee joint and can help identify the degree of knee misalignment.

• MRI: Magnetic resonance imaging may evaluate the soft tissues around the knee joint, such as ligaments and tendons.

• CT scan: A computed tomography scan may be ordered to obtain a detailed image of the bones and joints in the knee.

• Blood tests: Blood tests may be used to check for underlying medical conditions causing knock knees, such as vitamin D deficiency.

• Gait analysis: A gait analysis involves observing how a person walks or runs to determine if an abnormal movement pattern may contribute to the knee misalignment.

Based on the results of these diagnostic tests, the healthcare professional can make an accurate diagnosis and develop an appropriate knock knee surgery or treatment plan.

Treatments For Knock Knees

There are several treatment options for knock knees, including medication and surgery. Here are some details about each of these options:

Medications

• Vitamin D supplements: If a vitamin D deficiency causes knock knees, supplements may be prescribed to help increase vitamin D levels and improve bone health.

• Bisphosphonates: These medications can help increase bone density and may be prescribed for certain conditions that cause bone softening or weakness, such as osteoporosis or osteogenesis imperfecta.

• Pain relievers: If the knock knees are causing pain, over-the-counter pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to help manage the pain.

It is essential to consult with a healthcare professional before taking any medication to treat knock knees, as the underlying cause of the condition must be properly diagnosed to determine the appropriate course of treatment.

Surgery

Knock knee surgery may be necessary in severe cases to correct the knee alignment. The specific type of surgery will depend on the severity of the misalignment and the condition's underlying cause.

• Osteotomy: In this procedure, a surgeon cuts the bone in the lower leg or upper thigh and realigns it to correct the knee angle.

• Arthroplasty: This procedure involves removing a small portion of the bone in the knee joint to help realign the knee.

• Knee replacement: In cases of severe joint damage, knee replacement surgery may be necessary to correct the alignment and improve joint function.

Surgical treatment for knock knees is typically reserved for severe cases that do not respond to other forms of treatment, such as physical therapy or medication. It is essential to consult with a healthcare professional to determine if knock knee surgery is a viable option for your individual needs.

Impact Of Knock Knees On The Knees, Hips, And Ankles

Knock knees can significantly impact the knees, hips, and ankles due to the abnormal alignment of the legs. Some potential effects of knock knees include:

• Knee pain: The knee joint may experience abnormal pressure and wear, leading to pain, inflammation, and arthritis.

• Hip pain: The misalignment of the legs can cause the hips to become tilted and uneven, leading to pain and discomfort.

• Foot and ankle problems: The altered alignment of the legs can put excessive stress on the feet and ankles, leading to conditions such as flat feet, ankle sprains, and plantar fasciitis.

• Decreased mobility: Knock knees can affect a person's ability to move and walk normally, leading to decreased mobility and reduced quality of life.

Knock knees can lead to long-term joint damage and chronic pain if left untreated. It is essential to seek medical attention and consider knock knee surgery if you suspect you have knock knees or are experiencing joint pain or discomfort.

When To See A Doctor?

If you or someone you know is experiencing knock knees, it is essential to seek medical attention if any of the following apply:

• Pain or discomfort: If the knock knees are causing pain or discomfort, it is essential to see a doctor to determine the underlying cause and appropriate treatment.

• Difficulty walking or moving: If the knocked knees affect a person's mobility or ability to walk normally, seek medical attention.

• Joint instability: If the knocked knees are causing joint instability, increasing the risk of falls or injuries, seek medical attention.

• Noticeable misalignment: If the knock knees are prominent and causing self-esteem issues or interference with daily activities, it is essential to see a doctor to determine if treatment is necessary.

• Developmental concerns: If knock knees are present in a child and there are concerns about developmental delays or abnormal gait patterns, seek medical attention.

It is always better to address knock knees early, as early intervention can prevent long-term joint damage and improve overall joint health. A healthcare professional can provide an accurate diagnosis and recommend appropriate treatment options.

It not only gives rise to unsightly deformity and limp, but also has the potential to damage the knee in long term. Such knees develop early arthritis at later age. One of the common reasons for deformity in early childhood is a dietary deficiency of vitamin D, but in older children, more often than not the cause cannot be found.

Can Knock Knee Deformity Correct By Itself?

Dr. Vinay Aggarwal says, "Some amount of knock knee deformity is normal in children below 8 years of age, and gets corrected by itself as the child grows. Any deformity which persists after 8 years of age is not likely to correct by itself. Knock knees persisting at adolescent, and if bad enough, will require knee replacement surgery. It is possible to accurately define the degree of knock knee deformity by special ‘weight bearing’ X-ray of the whole leg, called hip-knee-ankle X-rays."

Is There A Method Of Correcting Knock Knees Without Surgery?

In the past, different types of modified shoes and braces have been used with a hope that the deformity would be corrected over time, but those have been found to be ineffective.  Any type of massage and diet does not help.

What Is key-Hole Surgery For knock Knee Correction?

This is a surgery where correction of the deformity is done through a 1 cm cut. It is done under anaesthesia. Through a small window in the bone, the deformed part of the bone is weakened from the inside with the help of a special tool called an osteotome.

Once the bone is weak enough and becomes pliable, it can be gently maneuvered into a corrected position. The leg is subsequently put in a plaster cast for 4 weeks to let the bone heal in the corrected position. There is no cutting of the muscles or the thin sheath (periosteum) covering the bone.

The deformity on both sides can be corrected at the same time. It does involve a period of bed rest and immobilization in plaster, but eventually, the leg becomes straight without major surgery, and with a little visible scar. This technique has been invented by the author taking into consideration that knock knees often affects young adolescent girls.

It is a cosmetic deformity, and the patient wants it corrected accept that they do not want the deformity to be exchanged with a scar of conventional surgery. Hence, one can call this technique “a cosmetic correction of a cosmetic deformity”. The author has performed this surgery on over 100 patients and has found it a successful operation, with a low (1%) requiring conventional open surgery if the bone re-displaces inside the plaster.

Conventionally, the surgery for correcting knock knees in a growing skeleton is, what is called ‘growth modulation surgery’.  This technique requires two operations - one for putting a ‘clip or plate’ to stop growth on the side of the rather rapidly growing bone, and the other to remove the clip after the deformity is corrected.

Correction happens slowly over years, and the child has to be under observation for all this period with repeated x-rays. The advantage is that there is no plaster immobilsation, and the child is more or less normally active during the duration of treatment.

There are complications associated with tinkering with a growth plate and that of a foreign implant. Of course, going to the operation theatre twice, and repeated visits to the hospital over a period extending over years is a big deterrent. Also, this surgery can only be done when there is sufficient growth potential left (between the age group of 12 to 14 years).

The other method of correcting knock knees is a corrective osteotomy. This is a formal open surgery technique, where the bone is exposed by a 10cm to 15cm incision, and the bone is cut and fixed with plates and screws to hold it in the corrected position. Though the advantage is that there is no need for plaster, but the complications related to open surgery, and the need for repeat surgery for the removal of the plate are a deterrent.

Can Key-Hole Surgery Be Done At Any Age And Any Degree Of Deformity?

The ideal age for performing the surgery is 8 to 16 years when the bones are relatively soft and heal faster. With growing age, the bones become harder and are difficult to weaken by this technique. Also at that age, the healing takes a longer time, and thus longer requirement of plaster immobilization. It is not recommended in patients older than 20 years, and in those with significant obesity.

Conclusion

While keyhole knocked knee surgery may be a viable option for some patients, it is essential to note that not all cases of knock knees can be treated with this technique. The suitability of keyhole surgery for a patient depends on several factors, especially the experience and skills of the surgeon. A healthcare professional can guide the individual toward the most appropriate treatment options.