Physeal stapling for idiopathic genu valgum

Adolescent idiopathic genu valgum may cause anterior knee pain, patellofemoral instability, circumduction gait, and difficulty running. The purpose of this study was to evaluate and discuss what we consider to be an ideal treatment protocol using hemiphyseal stapling. We reviewed 76 patients (152 knees) who underwent hemiphyseal stapling for idiopathic adolescent genu valgum and were followed up to maturity. Clinical evaluation included assessment of gait, limb length, alignment, and patellofemoral stability. Radiographic evaluation included measurement of the distal femoral angle (DFA), the anatomic femoral tibial angle (FTA), and the mechanical axis (MA) before stapling, at the time of staple removal, and at skeletal maturity. After stapling, we noted improvement in gait, clinical symptoms, and all radiographic parameters. Our conclusion is that adolescent genu valgum may cause significant symptoms including anterior knee pain and gait problems. Hemiphyseal stapling addresses the anatomic malalignment, alleviating symptoms while offering a high degree of patient satisfaction. It is safe and effective, with no premature physeal closures noted in our series. The procedure, which is well tolerated, obviates the need for corrective femoral osteotomies.