Orthopaedics of the knee: Bow legs and knock knees: Normally 5-7 degrees of valgus. More genu valgum, less genu varum. Catchy only if: progressive, unilateral, of recent onset. Gauging: Genu varum: intercondylar distance of 6cm Genu valgum: intermalleolar distance of 8cm

Physiologic bow legs and knock knees: Bow legs normal in babies, knock knees in 4 years olds. Only reassurance and 6 months follow up. If deformity continues at 10 years, stabling of physis is recommended. Compensatory deformities: As result of proximal femur deformities. Ant-eversion: squinting patellae, genu valgum, tibial torsion, and valgus heels.

Genu varum and valgum in adults: May be a sequel of childhood deformities, no concern normally unless combined with knee instability= predisposing to OA, in medial compartment or lateral. Genu valgum may cause mal-tracking of patella leading to OA in patello-femoral joint. Knee deformities are also common in OA (varum), RA (valgum). Genu recurvatum (hyperextension deformity): -Congenital: due to intra-uterine mal-position, recovers spontaneously.

-Lax ligaments: usually they stand with knees back-set, prolonged traction on a frame or hyperextension bracing causes the same. - paralytic conditions: polyo= equinus at ankle, leading to recurvatum if plantigrade is to be achieved (useful if mild). Meniscus lesions: Advantages of menisci: 1- Increase stability and congruence of knee 2- Controls the complex rolling and gliding 3- Load distribution

The menisci are made mainly of circumferential fibres making them difficult to be torn in width (except middle life and after, where fibrillation has taken place). Pathology: Medial meniscus mainly (less mobile). Types of tear: pocket handle (locking). Anterior horn, posterior tear. Menisci are avascular except of outer third. Clinical features: Yung adult, flexing the knee while taking weight and twisting (grinding twisting).

Swelling occurs a day after, pain localised to knee line. Investigations: X-rays: normal MRI: excellent Arthroscopy: immediate Rx. Rx: Conservative: 3-4 weeks in extension cast Operative: only if symptoms recurrent and unlockable knee.

Patello-femoral overload syndrome (patellar pain syndrome, chondromalacia of the patella): Anterior or patello-femoral knee pain Chondro-malacia is the cause?? Pathology: Repetitive mechanical overload of the patello-femoral joint due to incongruence of joint or mal-alignment of the extensor mechanism. Clinical features: Young adult or girl teenager, anterior knee pain, aggravated by climbing stairs, and standing after prolonged sitting.

Pain due to test. Rx: Conservative: vast majority adjustment of stressful activities and pt. Vastus medialis strengthening.