Treatment of genu valgum by a novel percutaneous transverse metaphyseal osteotomy of the distal femur in children and adolescents

Eur J Orthop Surg Traumatol. 2022 Aug;32(6):1179-1186. doi: 10.1007/s00590-021-03093-y. Epub 2021 Aug 14.


Purpose: To evaluate the outcomes of a novel percutaneous medial supracondylar femoral osteotomy and above-knee cast technique in children and adolescents as a minimally invasive surgical intervention for treatment of genu valgum.

Methods: In this prospective study, 60 patients (70 knees) with a tibiofemoral angle more than 15° were treated with a novel medial percutaneous supracondylar femoral osteotomy and above-knee cast and followed up for an average of 29 months. The radiological outcome was measured with MAD, TFA, and mLDFA. The functional outcome was evaluated by a modified Böstman score.

Results: The preoperative mean MAD, TFA, and mLDFA were 2.9 cm, 16.3°, and 79.2° respectively. The Böstman score averaged preoperatively 23.1. There was a significant improvement of all radiological and clinical outcome measures (P < 0.001). Per Böstman score, 2 knees in one patient (3%) showed an unsatisfactory result, while 14 (20%) and 54 (77%) knees had a good or excellent result, respectively. Two patients (three limbs) needed early re-casting. Other complications were not encountered.

Conclusion: In experienced hands, percutaneous transverse metaphyseal femoral osteotomy and above-knee casting appear to be a safe, supracondylar cost-effective, and reliable minimally invasive acute correction technique in genu valgum in children and adolescents.

Level of evidence: Level IV-therapeutic.

Keywords: Casting in genu valgum; Early mobilization in cast; Fast recovery and fast track surgery; Genu valgum in children and adolescents; Minimal invasive surgery (MIS) in limb deformity correction; Novel mini open femoral supracondylar osteotomy technique.

MeSH terms

  • Adolescent
  • Child
  • Femur / diagnostic imaging
  • Femur / surgery
  • Genu Valgum* / complications
  • Genu Valgum* / surgery
  • Humans
  • Knee Joint / diagnostic imaging
  • Knee Joint / surgery
  • Osteotomy / methods
  • Prospective Studies