Effectiveness of Medial Closing Wedge Osteotomy of the Distal Femur in the Management of Genu Valgum

Abstract

Genu valgum is a mechanical axis deviation lateral to the knee center that, when persistent in adolescents, leads to gait and functional disorders such as difficulty running, knee pain, patellar malalignment, lateral patellar instability, and ligamentous laxity. While physiologic valgus alignment is normal between two and seven years of age, chronic deformity beyond this period requires intervention. This prospective study was conducted at a private hospital (SISO) and a governmental hospital (UNAM) from May 2012 to April 2020, with a minimum follow‑up of two years. Inclusion criteria were unilateral or bilateral genu valgum with tibiofemoral angle (TFA) >12° and intermalleolar distance (IMD) >10 cm in the standing position, in patients aged 14–18 years, without metabolic abnormalities. Thirty‑four adolescents (56 knees) underwent closed wedge femoral osteotomy. Of these, 22 had bilateral deformity (64.7%), and 12 had unilateral (35.3%). The mean age was 15.6 ±1.3 years; 11 males (32.3%) and 23 females (67.7%). Presenting complaints included cosmetic deformity (67.6%), pain (11.8%), gait abnormalities (17.6%), and one case of a fall during walking. Postoperatively, IMD decreased significantly from 14.8 ±1.9 cm to 5.1 ±1.2 cm. TFA improved from 16.7 ±1.9° to 4.3 ±1.7° (p<0.001). Functional outcomes also improved, with mean Hospital for Special Surgery (HSS) scores rising to 84.2 points. Closed wedge femoral osteotomy, when performed with proper indication, meticulous preoperative planning, and stable internal fixation, provides reliable correction of adolescent genu valgum, enhances osteotomy stability, shortens partial weight‑bearing duration, and accelerates recovery, making it an excellent option for treating valgus knee deformity.