Systematic Literature Review and Meta-Analysis on Miserable Malalignment Syndrome

Background: Miserable malalignment syndrome (MMS) is a rare condition that entails increased femoral anteversion and increased external tibial torsion, as well as the presentation of one, some, or all the following: squinting patella, patella alta, patellar instability, an increased Q angle, genus valgus (knock knees) or genus varum (bow leggedness), genus recurvatum, feet pronation, or pes planus. Methods: The Sample, Phenomenon of Interest, Design, Evaluation, Research type search strategy was used to retrieve eligible studies from databases fitting the established inclusion criteria. Results: All studies agreed that nonoperative treatment is ineffective in improving MMS. Surgical treatment is effective, although it involves osteotomies at 2 levels per limb. Conclusions: Double-level osteotomies were effective in all studies, vastly improving range of motion, chronic knee pain, chronic hip pain, and other factors. Surgical treatment of this condition should only be reserved for severe cases because complications are possible. Level of Evidence: Most articles used were part of a case series, indicating this review article is based on level 4 evidence.