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Child Orthopedics
Spine - Cervical
Spine - Lumbar
Spine - Thoracic

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Have you heard of the miserable malalignment syndrome? Can you tell me what it is and what can be done about it?

The miserable malalignment syndrome refers to a group of anatomical changes in the lower extremity (leg) that can lead to knee pain and instability. The most common alterations include internal rotation of the femur (thigh bone). The rotation occurs at the distal (bottom) end where the femur helps form the knee joint. The second feature is an inward facing patella (knee cap) referred to as winking patella. The lower leg formed by the tibia and a smaller bone (the fibula) rotate outwardly under the femur. And below that, the feet (supporting the entire structure of the body) are flat. Changes in alignment like these anywhere along the kinetic chain can affect the position, movement, and function of the leg, especially the patellofemoral joint. The kinetic chain is the connection and force spread from foot to ankle to knee to thigh to hip. The patellofemoral joint is formed by the patella as it glides up and down over the front of the knee. For example, a flatfoot position shifts the hindfoot away from the midline toward the other foot. This is called hindfoot varus. Further up the kinetic chain, that slight change at the foot and ankle then cause an increase in the Q-angle of the knee. The Q-angle is a normal angle where the femur and the tibia (shinbone) come together at the knee joint. The patella normally sits at the center of this angle within the femoral groove. When the quadriceps muscle contracts, the angle in the knee straightens, pushing the patella to the outside of the knee. In cases where this angle is increased, the patella tends to shift outward with greater pressure. As the patella slides through the groove, it shifts to the outside. This places more pressure on one side than the other, leading to damage to the underlying articular cartilage. The miserable malalignment syndrome puts a person at increased risk for dislocation of the patella -- and not just once, but multiple times. The result can be a chronically unstable patellofemoral joint with ongoing pain and eventual arthritic changes.


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