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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.
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]
Surgical treatment is typically indicated for high-energy trauma fractures. [1] Intramedullary nailing is a common technique, but external fixation may have equivalent outcomes and be preferred under certain patient conditions that may preclude intramedullary nailing, such as the presence of a total knee arthroplasty. [6] [7]
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.
The location of the removed wedge of bone depends on where osteoarthritis has damaged the knee cartilage. The most common type of osteotomy performed on arthritic knees is a high tibial osteotomy, which addresses cartilage damage on the inside (medial) portion of the knee. The procedure usually takes 60 to 90 minutes to perform. [9]