Knee Deformities in Children With Down Syndrome: A Focus on Knee Malalignment

Area of Science:

• Orthopedics
• Genetics
• Pediatrics

Background:

• Patellofemoral instability (PFI) is a common knee abnormality in individuals with Down syndrome.
• Associated knee deformities and varied treatment outcomes necessitate further investigation.

Purpose of the Study:

• To delineate the anatomical variations of the knee in children with Down syndrome.
• To compare knees with and without PFI.
• To report on the management of knee abnormalities in this population.

Main Methods:

• Retrospective review of children with Down syndrome and knee abnormalities.
• Radiographic analysis of specific knee angles and translations.
• Comparison of anatomical measurements between knees with and without PFI.
• Subgroup analysis of PFI treatment (surgical valgus correction, soft tissue procedures, conservative).

Main Results:

• 5% of children with Down syndrome (31/581) presented with PFI in 56 knees.
• Knees with PFI showed increased valgus, larger distal femoral physis-joint angle, medial tibial plateau depression, and lateral tibial translation.
• Higher Insall-Salvati ratio and larger sulcus angle were observed in the PFI group.
• Surgical soft tissue procedures improved PFI grades, unlike valgus correction surgery.

Conclusions:

• Children with Down syndrome exhibit diverse knee anatomical variations.
• PFI is often accompanied by underlying deformities requiring a comprehensive treatment strategy.
• Anatomical assessment is crucial for planning effective PFI management in Down syndrome.