Lower Limb Rotational Malalignment: Derotational Osteotomies of the Femur and Tibia in the Setting of Recurrent Patellar Instability

Valgus lower extremity alignment with excessive femoral anteversion and tibial external torsion (Miserable Malalignment Syndrome) results in patellar maltracking. Sagittal plane deformities (rotational alignment) should be quantified along with typical frontal plane alignment. Femoral and tibial rotation can be assessed with both physical examination and radiographic studies. Derotational osteotomies of both the femur and the tibia can then be used for correction. In this chapter, we attempt to provide guidelines for assessing lower extremity rotation and an understanding of normal femoral and tibial rotational values. We then provide examples of corrective femoral osteotomies and tibial rotational osteotomies.