This condition involves a twisting or rotation of the bone, generally around the kneecap, making the kneecap unstable and it very difficult for the child to walk.
If physiotherapy has not been successful in treating this condition, surgery will be recommended. During the surgery, the surgeon will move the bones into the correct orientation and secure them in place with metalwork, resulting in a realigned, stable limb. As with any paediatric orthopaedic surgery, the surgeon will be cautious to not disrupt the growth plates (areas of new bone growth in children) during the procedure.
The surgery will then be followed up by an 8-week rehabilitation programme, where a specially trained paediatric physiotherapist supports the patient in building up their strength and mobility.
By the end of the physiotherapy programme, the child should have made a full recovery and within months should be able to engage in normal physical activity.
Knock knees are characterised by there being a visibly large gap between a person’s feet when they are standing with their knees together. Bow legs are the inverse of this, whereby the legs curve outwards whilst the feet touch.
For many children, developing either knock knees or bow legs is just a normal part of growing up and their legs will gradually straighten out as they grow. However, some more severe cases of these conditions can cause pain, a limp and make walking difficult.
For children who don’t grow out of their knock knees or bow legs, and whose symptoms are severe, surgery can be an option. Often the surgery carried out is a ‘guided growth’ operation, whereby small metal plates are placed on the inside of the knees. This helps correct and straighten the child’s knee positioning as they grow taller. The plates are generally left in for 12 months before being removed once the treatment is complete.
A child can usually start walking again within a few days of having a guided growth procedure and return to a good level of physical activity within weeks.
As children’s bones and ligaments are not fully developed, they can be more at risk than an adult of experiencing ligament damage, such as a torn or ruptured anterior cruciate ligament (ACL). This injury is becoming more common in active children who engage in sports such as skiing and football.
If the ACL is injured, the knee becomes unstable when in motion and can give way, as well as losing its full range of movement. As the knee gives way, the delicate structures inside it, as well as the joint surface and meniscal cartilages, may also be damaged.
If a child experiences an ACL injury, the ligament repair and reconstruction should be carried out as soon as possible for the best outcomes. Traditionally, this procedure has involved using a hamstring graft to create a new ligament, either from the patient or donated by a parent. However new, less extensive techniques for repairing ACL’s are being developed.
Orthopaedic Specialists have pioneered a new minimally invasive ACL repair technique for children, where the torn ligament can be reattached to the bone it was torn from, during keyhole surgery. The benefits of this type of surgery are that less damage is done to surrounding tissues, the need for the hamstring graft is removed and the return to activity is generally much faster than traditional surgery.