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Bone malrotation refers to the situation that results when a bone heals out of rotational alignment from another bone, or part of bone. It often occurs as the result of a surgical complication after a fracture where intramedullary nailing (IMN) occurs, [1] especially in the femur and tibial bones, but can also occur genetically at birth.
The proximal tibial attachment of the sMCL is the primary stabilizer to valgus force on the knee, whereas the distal tibial attachment is the primary stabilizer of external rotation at 30° of knee flexion. [3] [9] The dMCL is a thickening of the medial aspect of the capsule surrounding the knee.
In the third and most common mechanism, the dashboard injury mechanism, the knee experiences impact in a posterior direction during knee flexion toward the space above the tibia. [ 10 ] [ 15 ] These mechanisms occur in excessive external tibial rotation and during falls that induce a combination of extension and adduction of the tibia, which is ...
During a high tibial osteotomy, surgeons remove a wedge of bone from the outside of the knee, which causes the leg to bend slightly inward. This resembles the realigning of a bowlegged knee to a knock-kneed position. The patient's weight is transferred to the outside (lateral) portion of the knee, where the cartilage is still healthy. [10]
The greatest displacement of the meniscus is caused by external rotation, while internal rotation relaxes it. [1] During rotational movements of the tibia (with the knee flexed 90 degrees), the medial meniscus remains relatively fixed while the lateral part of the lateral meniscus is displaced across the tibial condyle below. [2]
The test is performed by slowly extending the knee from 90 degrees, maintaining internal rotation. Pain at 30 degrees of flexion and relief with tibial external rotation is indicative of OCD. [33] Physical examination of a patient with ankle OCD often returns symptoms of joint effusion, crepitus, and diffuse or localized tenderness.
The PCL is located within the knee joint where it stabilizes the articulating bones, particularly the femur and the tibia, during movement.It originates from the lateral edge of the medial femoral condyle and the roof of the intercondyle notch [2] then stretches, at a posterior and lateral angle, toward the posterior of the tibia just below its articular surface.
Rotationplasty allows the use of the knee joint, whereas amputation would result in loss of that joint. Therefore, it provides a better attachment point and range of motion for a prosthetic limb. As a result, children who have had rotationplasty can play sports, run, climb, and do more than would be possible with a jointless prosthetic.